CONVENTION ISSUE:
American College of Surgeons Clinical Congress
GENERALSURGERYNEWS.COM
October 2014 • Volume 41 • Number 10
The Independent Monthly Newspaper for the General Surgeon
Opinion
The Surgical Robot for Hernias: Converts and Holdouts
In the Dark B Y L AUREN K OSINKSI , MD
B Y C HRISTINA F RANGOU
T
he detailed plan that was rolled out at my hospital for responding to the surgeon who refuses to conduct the prescribed time-out at the start of each operation included a script for the nursing staff to address the surgeon, the leadership contact for emergency intercession, and instructions for the anesthesiologist to abort induction and for the surgical tech to roll the back table several feet from the operating room (OR) table. The final intervention to prevent the errant surgeon from seizing a tool and commencing the operation was to turn off the lights in the room—all of them.
Why surgeons must not disengage from the difficult discussions. I actually felt ill when I read this memo and tried to absorb how deeply broken relations in the OR must be, or are perceived to be, to inspire this directive. It was difficult to imagine an OR scenario in which it would be necessary to execute every step of the directive. As I inventoried my behavior as an attending surgeon—which I generally regard as somewhat flawed—to try to understand what would inspire this plan, I also reflected on the complex psychosocial agendas of all the staff in the room and the difficulty of making each person see IN THE DARK page 44
wo years ago, in a General Surgery Newss interview w about the surgical robot’s role in n hernia repair, laparoscopic surgeeon Karl LeBlanc, MD, answered unequivocally: “Inappropriate.” Today, despite no new evidence to the contrary, he has changed his mind. “I’ve had d to eat my words on that particcular topic,” he said. Dr. LeBlanc, a hernia su urgeon at the Surgeons Group of Batoon Rouge, in Louisiana, and clinicaal professor of surgery at the Louisiana State University School of Medicine, New Orleans, said he began to reconsider his opposition to the rob bot earlier this year after anecdotal reeports that patients experienced less ch hronic pain
B Y M ICHAEL V LESSIDES
see HERNIA ROBOT page 38
101 Tips for a Chief Surgical Resident B Y D EVIN F LAHERTY , DO, P H D ver the past five years, I have had the privilege of training under Marc A. Neff, MD. He not only taught me invaluable surgical skills in the operating room (OR), but also challenged me and my peers to perform continued self-evaluation. In 2013, at the beginning of my chief
INSIDE In the News
Opinion
Surgeons‘ Lounge
4
16
24
After More Than a Century, Debate on Hernia Repair Methods Is Stronger Than Ever
But Overall Opioid Use U changed in Lap Chole Study Un
T
O
The Politically Correct Operative
Report By Leo A. Gordon, MD
Your Reponses Requested! A case of a patient with a painful enlarging symptomatic umbilical hernia
Nausea, Vomiting Reduced With IV A Acetaminophen
year of surgical residency, I presented all residents in my program with Dr. Neff ’s “101 Tips for Surgical Internship,” published in General Surgery Newss in August 2012. Near the completion of my residency, Dr. Neff challenged me, one last time, to create my own list of see CHIEF RESIDENT page 41
MONTTREAL—Preliminary data indicate reducced postoperative/post-discharge naauseea and vomiting (PONV/PDNV) an nd improved patient satisfaction after a singgle dose of IV acetaminophen in paatien nts undergoing laparoscopic choleccysttectomy, compared with traditional op pioid-based anesthetics. Despite th his, the overall amount of opioid ad dmin nistered intraoperatively and in th he p postanesthesia care unit (PACU) waas n not reduced. “There have been a lot of reports, booth anecdotally and in the literature, ab boutt ways to help minimize PONV an nd p pain,” commented Daniel Bosshart, M assistant professor of anesthesiolMD, ogy at og a Hofstra North Shore–LIJ School of Medicine, in Hempstead, New York. “So, w “So we wanted to determine the effect of a single dose of IV acetaminophen on PONV, PDNV, pain and overall patient satisfaction.” Dr. Bosshart and his colleagues see LAP CHOLE page 12
REPORT Considerations in Selecting Mesh For Hernia Repair: Evaluating the Role of a Hybrid Hernia Device See insert at page 24