Impact of Surgical Smoke on the Surgical Team and Operating Room Nurses and its Reduction Strategies: A Systematic Review

Background: Surgical smoke is an integral part of surgical operations that the surgical team has been exposed to for so long. This study aimed to investigate the effects of smoke, on members of the surgical team. Methods: A systematic review was conducted focusing on the complexity of surgical smoke. PubMed, Scopus and web of science databases were searched until May 2020 without any time or language limitation. All documents were reviewed by title or abstract according to the search strategy. The screening process of articles was performed by two independent authors. The articles were selected according to the inclusion and exclusion criteria. Results: Overall, 37 studies in this systematic study were investigated. The effects of many surgical smokes were found in a nutshell including complications such as carcinogenic, toxicity, mutation, irritant, transmission of tumor cells, virus transmission, headaches, dizziness, sleepiness, headache, the bad odor in head hair, the tearing of the eye on the surgical team and staff. Conclusion: Surgical smoke, produced during surgical operations, is one of the risks and threats to which the surgical team and operating room staff are at risk then can affect the organs of different bodies from the body of all operating room staff and surgical team.

Use of an exoscope for enhanced visualization of a Schwab grade 5 osteotomy to correct kyphotic deformity

The development of the 3D exoscope has advanced intraoperative visualization by providing access to visual corridors that were previously difficult to obtain or maintain with traditional operating microscopes. Favorable ergonomics, maneuverability, and increased potential for instruction provide utility in a large range of procedures. Here, the authors demonstrate the exoscope system in a patient with progressive thoracolumbar junctional kyphosis with bony retropulsion of a T12–L1 fracture requiring a Schwab grade 5 osteotomy and fusion. The utilization of the exoscope provides visual access to the ventrolateral dura for the entire surgical team (surgeons, learners, and scrub nurse). The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21190

Experience of the surgical team in COVID-19 in a tertiary care hospital in Pakistan.

Objective: To analyse experience of the surgical team in COVID-19 in a tertiary care hospital in Pakistan. Study Design: Analytical Observational study. Setting: Department of Surgery, Tertiary Care Hospital Sialkot, Pakistan. Period: March to September 2020. Material & Methods: After the permission of ethical review committee (ERC/12/2020), data was collected by all four groups surgeons, Resident and internees, paramedical staff and other staff of surgical teams. A simple, 6 question-questionnaire, manually typed, was distributed to all members willing to complete and return the questionnaire. Data was analyzed by using SPSS-23. Results: Majority (91.27%) of the surgical team members got satisfactory training to handle with Covid-19 Cases. The 80 % was in fear to contract the disease while working in isolation and COVID-19 wards and about (76%) were well adjusted to their newly assigned duties. About 85% of surgical team members experienced prolong duty hours (12 hours a day) related stress and similar percentage participated in the management of surgeries done during this period. Conclusion: Surgical Team participated and adapted to meet the newly assigned duties to lookafter the isolation and COVID-19 wards. Team members experienced stress and fear of contracting disease was a matter of concern. However, it has taken care of all trauma, life-threatening emergencies and oncological cases adhering to use of principles of use of PPEs.

The current state of the surgical care team in the United Kingdom: Shall we ‘do a time out’?

The reduction of junior doctors’ working hours over the last two decades paved the way to non-medical practitioners providing care traditionally discharged by surgeons and other medics. These registered practitioners play a vital role in the care of patients in surgery and work within multi-disciplinary teams comprising surgical care practitioners, advanced clinical practitioners in surgery, and physician associates, with significant experience in nursing or allied health care professional practice. Health Education England and the Royal Colleges of Surgeons have invested considerably in developing the relevant educational frameworks to support and quality assure the training of non-medical practitioners. Notwithstanding, to ascertain whether advanced and extended practice have been developed appropriately, a wide critical stance is needed. This article aims to begin to analyse the status quo of the extended surgical team and of the associated pitfalls and challenges, making conservative comparisons between the roles with the international scene. The objective is to help students, trainees and all involved in surgical care to adopt an informed and critical viewpoint about the extended surgical team in the United Kingdom, in the hope that this can lead to improvement and forward planning in workforce design for the benefit of patients and their communities.

An Evaluation of YouTube Videos as a Surgical Instructional Tool for Endoscopic Endonasal Approaches in Otolaryngology

Objectives Online surgical videos are an increasingly popular resource for surgical trainees, especially in the context of the COVID-19 pandemic. Our objective was to assess the instructional quality of the YouTube videos of the transsphenoidal surgical approach (TSA), using LAParoscopic surgery Video Educational Guidelines (LAP-VEGaS). Methods YouTube TSA videos were searched using 5 keywords. Video characteristics were recorded. Two fellowship-trained rhinologists evaluated videos using LAP-VEGaS (scale 0 [worst] to 18 [best]). Results The searches produced 43 unique, unduplicated videos for analysis. Mean video length 7 minutes (standard deviation [SD] = 13), mean viewership was 16 017 views (SD = 29 415), and mean total LAP-VEGaS score was 9 (SD = 3). The LAP-VEGaS criteria with the lowest mean scores were presentation of the positioning of the patient/surgical team (mean = 0.2; SD = 0.6) and the procedure outcomes (mean = 0.4; SD = 0.6). There was substantial interrater agreement (κ = 0.71). Conclusions LAP-VEGaS, initially developed for laparoscopic procedures, is useful for evaluating TSA instructional videos. There is an opportunity to improve the quality of these videos.

AMPATH Surgical App: Open Appendectomy

Background/Objective: Due to a geographic shortage of surgical providers within Kenya, doctors without surgical training are expected to complete emergency surgical procedures. The Academic Model Providing Access to Healthcare (AMPATH) surgical team is developing an education module, delivered via mobile phone app and self-made simulators, dedicated to the skills necessary to complete open appendectomy. We hypothesize that our model and curriculum will provide a low-cost method of effectively simulating the open appendectomy. Methods: After developing a step-based curriculum, an initial prototype of a model for the appendectomy was constructed. Expert academic surgeons from Indiana University were identified to test the prototype by performing an open appendectomy on the model. Feedback on both the model and the procedure was obtained via recorded video and REDCap. Results: A total of 8 expert surgeons were consulted on the model, each presented with an updated version of the appendectomy model and procedure based on feedback. Experts provided feedback on the model and each substep of the curriculum. Overall, the curriculum was clear with each substep receiving a median score of at least 82 out of 100 for clarity. While the model received lower scores in utility and “realism, expert feedback was incorporated in an iterative process such that latter models demonstrated net improvement in the realism and utility of several substeps, including “the appendectomy”. Conclusion: A low-cost appendectomy model with corresponding curriculum was developed, and refined with expert feedback, to facilitate this project’s transition to its next stage – testing on medical trainees. Additionally, the model and curriculum will enable the development of an AI algorithm to give the learner real-time feedback as they perform the simulation. Implications: Ultimately, this study may create a platform that increases access to best possible practice and improves outcomes in settings where surgical education is limited.

Optimizing management of sickle cell disease in patients undergoing surgery

Individuals with sickle cell disease (SCD) are likely to be referred for surgery at some point in their lifetime due to a high incidence of musculoskeletal and intrabdominal complications such as avascular necrosis and gallbladder disease. Preoperative optimization is a multidisciplinary process that involves a hematologist with SCD expertise, an anesthesiologist, and the surgical team. The type and risk classification of the surgery, disease severity, medications, baseline hemoglobin, transfusion history, and history of prior surgical complications are often documented. Clinicians should consider perioperative risk assessment that includes determining the patient's functional status and cardiovascular risk and screening for obstructive sleep apnea. Many patients will require preoperative transfusion to reduce the risk of postoperative complications such as acute chest syndrome and vaso-occlusive pain crises. The hematologist should consider the patient's preoperative transfusion requirements and ensure that the surgical team has an appropriate plan for postoperative observation and management. This often includes follow-up laboratory studies, a postoperative pain management plan, and venous thromboembolism prophylaxis. The transfusion plan should be patient-specific and take into account the SCD genotype, baseline hemoglobin, disease severity, risk classification of the surgery, and history of prior surgical complications. In the intraoperative and postoperative period, dehydration, hypothermia, hypotension, hypoxia, and acidosis should be avoided, and incentive spirometry should be utilized to minimize complications such as acute chest syndrome. In this review we discuss preoperative, intraoperative, and postoperative strategies to optimize patients with SCD undergoing surgery.

Sclerosing angiomatoid nodular transformation of the spleen: a case report

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an uncommon primary benign condition with specific histopathological characteristics. The majority of the patients are usually asymptomatic and present for treatment after an incidental finding on a routine abdominal imaging. The differential diagnosis includes other benign tumours, as well as primary malignancy or metastases of unknown origin. We report a 55-year-old woman who was presented to the surgical team of our hospital for splenectomy after the investigation of an incidental splenic lesion led to the diagnosis of SANT. The pathology report of the specimen repeated the initial diagnosis. The patient has not yet presented any complication or recurrence of the disease 8 months after the operation. From such infrequent cases, the most valuable conclusion which can be yielded is that the more the number of patients reported, the more the knowledge about the disease is broadened.