What’s New in the World of Surgery
DaVinci, Mako, Central Service
DaVinci, Mako, Central Service
What was the purpose of participating in this program?
A little background on Nancy Dupee, I am a certified surgical technologist/first assistant.
I went through the surgical tech program at Mid-State Technical school. When I applied for the program, my goal was to work as a surgical tech in the Cath Lab. As I rotated through the different areas and specialties within the operating room, I knew the Cath Lab was not what I was looking for.
There were so many opportunities to explore and expand my learning base. I took a position at Saint Joseph’s Hospital on the ortho team. It was a great learning experience, total hips, total knees, spine and many others. We had patients of all ages, I did eventually work in peds ortho, helping children with deformities.
• I did leave the operating room to join the plastic surgery group. I wanted to see the before, during and after of why people come to the operating room. Working with patients of all ages, many different types of procedures from reconstruction to elective surgeries. One of the most rewarding surgeries we were involved in were cleft lip and palate surgery for children born with disformaties. We had a cleft lip and palate clinic where there were many different teams involved to assist with the children. ENT, audiology, plastics, speech, and a few others, we met with different groups of children each month to work as a team to assist with making things better for each of them.
• After about five years, I left plastics and returned to the operating room, so I was able to assist with the Surgical Tech program at Mid-State, as a clinical instructor. I served in that role for 20+ years and enjoyed watching the students progress from the beginning to graduation. When the former instructor retired, I applied for the position that I am in.
• It has been about four years and there have been many changes, and to keep up with them, I applied to participate in this program.
• There are many changes that occur each year with keeping up with technology.
• I have been out of the workforce for four years and I wanted to learn a little more about DaVinci Surgery, Mako ( robotic orthopedic surgery) and central service changes.
• Contacting the three clinical sites we have rotations with; Marshfield Medical Center, Aspirus Stevens Point Hospital and Aspirus Riverview Hospital, to see if they would allow me to view the different procedures offered at their facility. All three were willing to have me see the changes, unfortunately, I did not attend Aspirus Riverview, they thought that I would get more out of the other facility since they have the newer technology.
• I was able to participate in many different DaVinci Surgeries, Mako surgeries and discuss the changes in the central service department.
• What is DaVinci Surgery-is a minimally invasive surgery that uses a robot to assist surgeons with complex surgeries. There are four components to the system, bed, surgeons' council, arms and monitor. They all need to communicate with each other to work properly.
• https://www.youtube.com/watch?v=0UJ8r4iNhDQ
• Aspirus Stevens Point- the nurse turns it on, and it goes through its own set of checks. They will dock the system from the patients left side.
• Marshfield- either the tech or nurse will turn it on. They normally will dock the system from the foot of the patient.
• The tech will drape all four arms with long plastic sleeves that have magnets on the top to hold it in place. There is a long drape that attaches to the back plate, so the arms do not get contaminated when it is stored. Tech will be responsible for switching the instruments and inserting supplies if needed.
• When attaching the instruments, when they are attached to the arms, there are 4-6 dials that will spin to make the connection, you will hear a click. This will hold them into place and moves according to the surgeons' movements. There are cords that attach to the instruments for bipolar and monopolar cauterization on the tips. The surgeon will activate it with a foot pedal on the council.
• With this action, it allows the surgeon to manipulate them in more movements than they would if they were performing it in an open procedure.
• Aspirus Stevens Point
Marshfield Medical Center
• What is the Mako system- robotic arm assisted surgery, allows surgeons to make more precise cuts.
• The rep will bring the system into the room, making sure it has gone through all the checks. The tech will drape it and attach the sterile components of the unit. This allows for a saw or other components to be attached. On the screen, it will show a green area for the surgeon to follow and as they are removing the bone the green will disappear allowing them to know when they have completed the cut.
• https://www.youtube.com/watch?v=NQMIgcaJbeM
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• This was interesting to watch since I am used to the old way of doing things. When I was still working, they used a mixture to assist with bleeding that they would inject into the tissues at the end of the case and assist with pain control. This mixture they called an ortho cocktail, they would need to have pharmacy make it and it was only good for 2 hours and if they didn’t use it, they needed to toss it out. The new mixture is call RECK- Ropivacaine, Epi, CloNIDline HCI, Ketorolac, this would be injected at the end of the case for pain control. This mixture are in ready to use 50 cc syringes, shelf life of about 3 months. This is more convenient, cost affective, and doesn’t require pharmacy mix it up.
• They also use Tranexamic Acid (TXA), which slows down or stops blood clots from being broken down. I noticed they poured half of it in the wound at the middle of the case and then again at the end. This will assist with pain control and bleeding for 2-8 days.
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• There have been many changes in the central service department, both facilities have newly rotavated departments. Which benefits both the facility and patients. Both departments were very helpful with discussing how each item worked. They start out in Decam, where they wash the instruments, each item goes through the ultrasonic washer (as pictured left) which assist with getting into each area of the instrument. They have attachments that allow them to hook up to daVinci instruments and other instruments that have lumens to flush them out. Moving to the washer disinfector, which is like a big dishwasher. (as pictured middle) In the past they had big drums of cleaning solutions, now they are individual and programed to the amount that would be used. (as pictured right)
• When they are finished washing, they will come out into the assembly side of the department. This is where staff will assemble sets for sterilization. A nice change they have made is each workstation is moveable, allowing staff to adjust it to a comfortable working area.(as pictured left) After assembling they will go into the sterilizer and then to the storage area until they are needed for the next procedure. They will then be put on case cards for each surgery. (as pictured right from Stevens Point)
Name: Daniel Wall _______________________________________________
WTCS District: Mid-State Technical College
Faculty Member reviewing: Nancy Dupee
Partnering Business/Industry:
Location of Participation:
Dates of Participation: Beginning: Ending
Please reflect on your experience while responding to the following questions:
1) How has the participant improved instruction resulting from participation in the program?
Participating in this program has equipped Nancy with updated knowledge in current surgical practices, particularly in robotic surgery. Prior to this program, Nancy hadn't been in an operating room for over three years, and she had limited exposure to mode rn surgical robots. With robotic surgery becoming the standard of care, it's crucial for MidState students to grasp its concepts before graduating. With over 12 million cases completed globally and more than 60,000 surgeons trained on the DaVinci system, it's evident that robotic surgery is widely embraced.
Several hospitals within the Mid-State district utilize DaVinci Robots, and Nancy's participation in this program has provided her with hands-on experience in robotic surgical cases using the DaVinci system. This practical exposure has granted Nancy firsthand knowledge of its operation, bolstering her confidence in teaching the subject matter. Moreover, it enables her to better address students' inquiries regarding current surgical practices and the impact of surgical robots on these practices. This not only enhances Nancy's effectiveness as an educator but also offers students a broader perspective, enriching their overall learning journey.
2) How has the college encouraged development and/or participation in a faculty learning community based on the training the faculty member received from the industry?
Mid-State Technical College is committed to Nancy's ongoing growth and improvement. We actively promote her participation in various programs and provide resources to support her continuous learning and development. By investing in initiatives that bolster Nancy's expertise in her field, we empower educators like her to deliver top-notch instruction that prepares students for their future careers.
Our dedication to nurturing faculty growth not only fosters a culture of excellence within our institution but also directly contributes to student success both inside and outside the classroom. We believe that by investing in Nancy's development, we're investing in the success of our students and the overall quality of education we provide.
1. How the participant improved instruction resulting from participation in the program.
By contacting our clinical affiliates, I could view and communicate with staff about the changes and how each system worked. Also discussing with surgeons how they feel these new concepts have improved their ways of performing the surgeries. When we are in the classroom discussing these systems, I can give a better description and pertinent information to students.
2. How skills improved in occupational area resulting from participation in the program.
Having the knowledge to discuss with students pertaining to these surgeries. Learning how they work, and I was able to drape the daVinci, to understand how it was done and being able to move the arms giving me a feel of the working of the unit. I contaminated a section of the drape with it touching one elbow of the arm. I was happy it was not the real thing, but maybe I would have been more conscious of my actions. It also allowed me to talk to the different reps from the companies which will allow us to have them give a demonstration in our classroom or at the clinical site. We have exchanged information so we can connect this fall.
3. Technological updates and advancements in specific education department resulting from participation in the program. Technology will continue to change, everything used to be laparoscopic, now they are moving to daVinci, who knows what the next stage of technology will be. I feel that the Mako system will also be advancing in the future, with the older surgeons retiring and the younger ones wanting modern technology that they were trained to work with.
1. Development, enhancement and/or maintenance of business/industry knowledge. Having open communication with our business/industry staff assists with staying up to date on what is new and what might be coming. While I was there, it allowed me to communicate with the management to find out what I can do to improve the program to assist with presenting knowledgeable student in the future. They were willing to share things that they have been thinking about and will continue to keep me informed about it in the future.
2. Development and/or participation in a faculty and/or staff learning community
I am happy that I had the opportunity to do this, I feel it will make me a better instructor for my students and want to continue to go back to the sites for visits and to keep up with what is happening. I think this would be a great experience for anyone who has been out of the profession for a while. Thank you for letting me have this experience and to advance my knowledge.
• Thank you for this opportunity and I hope you have learned a little about:
• DaVinci
• Mako
• Central Service
• The facilities we are partnered with have been very accommodating and assisting with a great learning experience for myself as well as the students in Mid-State Technical College’s Surgical Technology course.
• This was a rewarding experience.