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Are Seasoned Surgeons Still Safe in a Laparoscopic Surgical Crisis?
Kinga a. Powers*1,2, Scott Rehrig1, Noel Irias1, Mark P. Callery1, Steven D. Schwaitzberg2, Daniel B. Jones1
1Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 2Surgery, Cambridge Health Alliance, Harvard Medical School, Boston, MA
Seasoned surgeons are confronted with emerging technologies which were not part of their formal residency training. Our aim was to compare technical and team performances of surgeons of different ages and expertise. We hypothesize that seasoned surgeons are less prepared to deal with a laparoscopic surgical crisis than younger, expert laparoscopic surgeons.
Methods: Six seasoned surgeons (age 55-83) were compared to six control, expert laparoscopic surgeons (age 34-53). In a simulation mock operating room, surgeons established pneumoperitoneum, trocar access, and managed an intraabdominal hemorrhage in a previously described and validated model of an abdomen. Blood loss and time to control hemorrhage were measured. Videos were evaluated as part of an approved IRB. Surgeons’ performance in the simulated operating endosuite was assessed using described and validated technical and team performance scales. Statistics were by SAS/STAT software with p <0.05 significance.
Results: All seasoned surgeons when confronted with the use of unfamiliar technologies (Veress needle and optical trocar) used junior assistants appropriately. All control surgeons achieved intraabdominal pneumoperitoneum and trocar entry themselves. Mean blood loss for seasoned surgeons and control surgeons was 2.7 versus 2.8 liters, respectively (p=NS). Bleeding was successfully managed laparoscopically by two senior teams and one control team. On hemorrhage recognition, senior surgeons converted after 2:40 min vs. 3:30 min for the control surgeons (p=NS). Overall technical and team abilities of both groups were comparable. On debriefing, 85% of all surgeons recommended simulation for recertification.
Conclusions: Seasoned surgeons use their assistant surgeons well and are safe even when confronted with emerging technologies. Conversion to laparotomy addresses hemmorrhage during laparoscopic crisis. Simulation may prove a valuable tool for self assessment and recredentialing.
