The mystery of the speed of general surgery
From the time a patient enters the operating room to the time he or she is wheeled out at the end of surgery. –Speed as seen by the patient
From the start of anesthesia to the end of surgery. –Speed on the surgery sheet
From the start of surgery to the end of surgery. — Speed as seen by the surgeon
It is easy to see the difference.
Regardless of the type of surgery, the procedure, or the swiftness of the operation, there is only one basis for evaluation: total time.
Who is in charge of speed?
As we already know, the real meaning of speed is the length of time spent in surgery. It is a special time trial, with only a starting point and an end point, with different conditions, different modalities and different procedures, but to see who takes less time. It’s not one game that determines the winner, but an unlimited number of games.
Let’s take a closer look at what determines the speed of surgery? Without a doubt, the condition is the main factor. But you can’t choose the condition, you won’t always be so unlucky or so lucky. So for the speed of surgery, the condition can be ignored.
Now, the surgeon’s factor is the first one, and since it is the focus of this article, it will be ignored for now. Other factors that affect the speed of surgery are: anesthesia, instruments, and nurses. But like the condition, they can all be ignored in the competition of surgical speed.
Therefore, the final conclusion is that the surgeon is the most dominant factor, and arguably the only dominant factor, that affects the speed of surgery.
How does the surgeon dictate the speed of surgery?
First, let’s clarify the concept that the surgeon is a surgical team, not just the main surgeon. What is the most important of the surgeon’s factors?
On the surface, it should be the technical level of the main surgeon, because he has to judge the condition, determine the surgical approach, perform the main operations, and harmonize the teamwork. But there are many highly skilled specialists who do not operate as quickly, or even more slowly.
It takes years of honing a surgeon’s skill level to improve, and are you really willing to wait any longer? Who can guarantee that you won’t become an old specialist with a high level and low speed? Can you really not go any faster at your current skill level? Don’t worry, the answer is about to be revealed!
Surgery time: a clear and confusing account
If you keep a tally of your own or your colleagues’ surgical times, record the people who completed each step of the operation and the sequence, and then record the time it took to complete a single operation.
When you analyze the data after surgery, the results are surprising: the time for each operation is multiplied by the number of times, and then the various operations are added together to get a theoretical operating time that is far different from the actual operating time? If we take into account that many operations are performed at the same time and that there is an overlap in time, the gap between the two would be further widened. Where exactly does the time go?
Perhaps you are already a little confused, let’s skip the complicated analysis process and look directly at the conclusion.
1. clamping, suturing, ligation, wire cutting, separation alone occupy time, the most direct impact, and among them, suturing, ligation with the greatest time elasticity.
2. pulling hooks, revealing, observing and thinking, should be able to be performed simultaneously with other operations, but often occupy time alone, or often repeat the work.
3. The transition process between two operations takes more time. Waiting – often interrupts the continuous surgical procedure.
The immediate effect of speeding up
Have you ever noticed that the director’s surgery time is much faster than yours, why?
One of them is crucial: stealing the concept
You may not have thought of it because the director goes to the operating room later and comes out earlier. In the eyes of the patient the director’s surgery time is the most narrowly defined surgery time! Of course you can’t also go late, but you can find ways to make your surgery time a little narrower as well. There are many ways to do this, think for yourself, don’t get bad ideas.
The accumulation of less to more by speeding up
I once did a simple experiment to convince a young surgeon of the importance of applying the basics wisely, the same one major gastric resection, the same main incision, the same pulling hook, the only difference being that one was tied by me and the other by the young surgeon, and I did no additional work beyond that.
As a result, the time difference was 25 minutes after almost 100 square knots for a large part of the stomach. Why was there such a big difference? Was it because I tied the knots faster?
No. To ensure a safe and smooth operation, each knot must be tied carefully and firmly. If a blood vessel is torn out because of a bad knot, there may be enough time to stop the bleeding to tie 100 more knots. What is even worse is the postoperative bleeding.
Therefore, tying each knot carefully is the best acceleration. So, where does the time come from?
1. when ligating the vessel, the main surgeon takes the scissors and you take the thread, and after cutting the vessel, you immediately set the thread and ligated it.
2. when suturing the left hand first grab the end of the line, the right hand flip waiting to grab the line.
3. shallow part of the knot the first knot must let yourself and the main knife can see, before the first time loose clamp.
4. The posture of grasping the thread at any time is the posture of preparing to tie the knot.
5. Tighten the first knot in a position that is just ready for the second knot.
6. Learn to close the deep knot with one hand to avoid backhanding. (Not only does it affect the speed, but the main thing is that the knot will be loose)
7. Immediately after tying the knot, bring the threads together and expose the threads to the thread cutter without pointing at the cutter.
Just a few tips for tying knots, each one should save 1 second, and a little goes a long way.
Speeding up the unsung hero hook pull
Don’t be disappointed if you can only pull the hook now, you are the real unsung hero of speeding up the procedure! So how does the hook help speed up?
1. The hidden hook. A really good hook pull can make the surgeon forget the existence of the hook puller. Why do people say about the hook puller: persistent hook pulling and paroxysmal bear taking? That’s because only when there is a problem with the hook puller will the surgeon’s attention be drawn to it, and if you can make the main surgeon forget you exist, you are the best assistant.
2. The hook puller is often a young surgeon or intern who is not familiar with how to place the hook and knows little about the effect the hook should produce and actually produces, and is not even qualified to look at it.
Therefore, asking the puller to reveal the good to the primary surgeon himself is an imposition. The main knife must personally put the pulling hook into place by himself, and then give it to the puller to fix, and give a clear account of the pulling hook strength, depth, and direction of force. When you need to adjust the adjustment should also be personally adjusted.
3. The hook puller is a heavy work and requires more attention than other surgeons, so he/she should not take on other duties, such as wire cutting, suction, hemostasis, etc., and should avoid any work that requires activity.
4. The hooker always keeps in mind that the hook is pulled for the main knife! It doesn’t matter if you can see it yourself, it is best not to see it, so as not to appear to pull away with the hook and block it with your head.
Speed up the reputation of the master knife
The previous talked separately about how the assistants struggle to improve the speed of surgery, it seems that none of them are very difficult, the master knife and how should it be? In this surgical team the master surgeon is like the boss, but the boss also has the difficulties of the boss: the masses have someone to send money, accumulate a small amount of money to slowly save; the boss head blue sky, create wealth by development. Master surgeons want to really improve the speed of surgery, there are few shortcuts, improve their own may be the best way. People who have done primary surgery know that surgery is not something you want to get up fast.