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Simplifying Surgery

The following article ‘Simplifying Surgery’ was very kindly written for the Vetlink blog by Dr Mark Glyde. I would like to thank Mark most sincerely for the article.

Mark leads Murdoch University’s busy Orthopaedic and Neurosurgery Referral Service. He is a Diplomate of the European College of Veterinary Surgeons and an internationally recognised surgeon and teacher.

Plan and Prepare:
Be familiar with the surgical technique / anatomy / potential intraoperative complications. With a common surgery like a spay, know how to get to the caudal pole of the kidney in advance. Do you know the duodenal and colonic “basket” manoeuvres that make this easy?

With a less common surgery like an orthopaedic surgery think it through first – make sure you have a Plan A – and a Plan B just in case things aren’t straightforward!

Is this surgery within your reasonable capacity?
Would you do the same procedure on your own pet? Can the postoperative care requirements be adequately provided by your staff and your practice? Your patient, owners and our profession don’t expect omnicompetence. They do however expect competence.  If you are not sure seek advice within the practice or from colleagues or seek referral if appropriate.

Clip and drape adequately:
Visualisation is key. Working through a small fenestrated drape may be appropriate for an uncomplicated spay. It greatly limits your ability to resolve a complication like a dropped ovarian pedicle where cranial extension of the incision hugely simplifies finding the bleeder. Explain to your nurses why the whole abdomen should be prepped for that 1 in a 1000 “just in case”.

For most orthopaedic surgeries fenestrated cloth drapes are not appropriate. Free-draping with disposable waterproof drapes is the basic standard. It not only improves visualisation and reduces infection- it is cheaper!

Patient positioning:
Patient positioning can be the difference between an easy surgery and a difficult and ultimately compromised surgery. This is particularly the case with orthopaedics.

Lighting:
Lighting needs to be focused and directable intraop. Visualisation is key. The deeper the abdomen and the smaller the joint the more important good lighting is. Similarly suction for abdominal, joint and other surgeries makes your life easier and makes a difference to outcome. Suction is cheaper than you think.

Give yourself an extra hand:
More complex surgeries like abdominal exploratories and many joint surgeries are not easy. Make life easier and do a better job by getting a colleague or trained nurse to scrub in or at the very least use self-retaining retractors. Most specialists do – and they do these procedures every day – why don’t you?

Critically review your work:
Reviewing the results of your surgery fast tracks your improvement. Even better, make a pact with a work colleague or friend to honestly critique your postop radiographs etc.

Lifelong learning:
Take every opportunity to practice and refine your diagnostic and decision-making and surgical skills through the many learning opportunities that are available today. Your learning doesn’t stop after graduation. The real learning just begins!

 

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