Tag: surgery

Categories : Hospitals Medical Research & TechnologyTags :

Research Shows Surgical Simulation Training Improves Performance

On By ModernMedia
Photo by Tim Cooper on Unsplash

Success with independent surgical simulation training has made it the new normal for students at the Pan Am Clinic.

Traditionally, surgical resident training has been master–apprentice-type relationship, with gradually increasing responsibilities until the trainees can do procedures on their own. Given recent pressures in the health care system, including reduced operating room time, increased difficulty of procedures and working hour restrictions, there is less time for residents to learn using the traditional method.

Surgical simulation, a surprisingly old system, dates back nearly 2500 years, when they were first used to plan innovative procedures while maintaining patient safety. One of the first recorded instances of surgical simulation was the use of leaf and clay models in India around 600 BC to conceptualise nasal reconstruction with a forehead flap

In a recent study, researchers from the University of Manitoba and the Pan Am Clinic recently examined the effectiveness of a mixed reality simulator for the training of arthroscopy novices.

Study author Dr Samuel Larrivée said: “Sports surgeons at our institution noted anecdotally that junior residents had difficulty reaching competency in arthroscopic skills by the end of their three-month rotation, and were not as prepared when starting their senior rotation. There was a need to increase training opportunities outside of the operating room in order to prepare our residents for independent practice.”

Prior to obtaining the ArthroS™ simulator, the University of Manitoba Orthopedic Surgery program occasionally made use of options such as benchtop dry simulators, cadavers and an older generation simulator with active haptics. These largely complemented academic teaching sessions in small groups with some success, and were available for use by residents as needed. But, due to the low fidelity and difficult setup, few residents took advantage of it.

However, medical students readily took to the ArthroS simulator. Alisha Beaudoin, a co-author and medical student, attested to her experience using the ArthroS simulator in her early training. “I found this training to be very helpful during my surgery rotation. Many of my preceptors were impressed by my superior arthroscopic and laparoscopic skills. This training may allow students with an interest in surgery to be more prepared.

“Recently, many Canadian universities have moved to competency-based curriculums where residents must demonstrate competency prior to moving to the next defined practice level. The study noted that this is similar to the training available on VirtaMed ArthroS and that “a user enrolled in the mentoring program is progressed through various levels of training by meeting training targets, essentially providing a proficiency-based progression.”

This paper is the first in what the authors hope is a larger body of work on validating arthroscopy simulators for resident training. There are currently plans to repeat similar studies with the other modules (hip, shoulder, and ankle), with larger sample sizes, and at different levels of training.

Participants were split into three groups: simulator training only, mentor-based training, and a control. After  four weeks, surgical performance improved among both traditional and simulator-based training groups. The study concluded that “simulator training may provide enhanced skills to improve patient safety overall, as residents may become more skilled earlier in their training, leaving more time for the mentor to teach more advanced skills.” Dr Beaudoin further explains: “I believe that simulation training should be introduced into the standardised curriculum because I believe it offers a safe space to hone your skills and improve in a stress-free environment.”

On the strength of the results, the residency programme has made it a requirement in the curriculum that residents in their sports rotation complete the self-learning modules. Dr Larrivée believes this will help residents develop their triangulation skills and memorise the steps ahead of their first surgery, and to consolidate their knowledge.

Source: VirtaMed

Categories : Pain ManagementTags :

Patient Awake for 13 Minutes During Surgery

On By ModernMedia

A patient in the US was awake for 13 minutes of his surgery because apparently his anaesthetic was never turned on.

In mid-2020 the patient, Matthew Caswell went into Progress West Hospital in O’Fallon, Missouri, for hernia repair and removal of a lipoma on the back of his neck.

However, he soon became aware that something was amiss.

“I knew I was in trouble when I felt the cold iodine hit my belly and they were scrubbing me off. At any second I was waiting to go out, but all of a sudden I just got stabbed in my stomach,” Caswell told local TV station KCTV.

Caswell’s lawyer Kenneth Vuylsteke told MedPage Today that a paralytic agent had already been given to his client, and then the mask was put on to receive sevoflurane for general anaesthesia, but the flow of the gas was never started.

Caswell able to feel pain and hear operating room conversation for 13 minutes, he told KCTV.

During this, his vital signs surged, said Vuylsteke. Records shared with MedPage Today show a baseline heart rate in the 65 to 70 range, which skyrocketed to 115 beats per minute within a few minutes of the first incision.

After the first incision, Caswell’s blood pressure also shot up, from a baseline of 113/73 mm Hg to 158/113 mm Hg — severe hypertension.

Vuylsteke noted that hat should have been ample warning that something was likely wrong with the anaesthetic.

What he gathered so far is that Caswell was brought into the operating room and given the paralytic agent. The anaesthesiologist or the nurse anesthetist put the anaesthetic mask on him, but then the surgeon requested to see the lipoma before starting.

Caswell was turned over so the surgeon could see the lipoma. He was then put onto his back again, and the mask was put back on, but the sevoflurane was never turned on, Vuylsteke said.

A “Significant Event Note” is in hospital records that acknowledges that a “review of the anesthetic record demonstrates a delay in initiating inhalational anesthetic after induction of anesthesia.”

The note indicates that Caswell and his mother were “immediately informed regarding the delay in initiating the inhaled anesthetic agent until after the start of the surgical procedure.” The hospital “provided emotional support and discussed our intention to ensure his pain and anxiety over the event were well controlled in the immediate term.” The hospital also recommended a psychology consult for which they would cover the cost.

Caswell charges that he’s suffering from post-traumatic stress disorder and panic attacks because of the experience.

He’s suing the anaesthesiologist, the nurse anaesthetist Kathleen and also their employer, Washington University in St Louis.

“I would have rather died on that table,” he told KCTV.

Source: MedPage Today

Categories : General InterestTags :

Russian Doctors Perform Heart Surgery in Burning Hospital

On By ModernMedia

Russian doctors stayed behind in a burning hospital to complete open-heart surgery on a patient after a fire broke out on the roof while they were operating.

It took firefighters over two hours to put out the blaze in the city of Blagoveshchensk. Using fans to keep smoke out of the operating room where a group of eight doctors and nurses was working on the patient, they also ran a power cable in to keep it supplied with electricity.

The heart bypass operation was finished in two hours before removing the patient to another site, the emergencies ministry said.

“There’s nothing else we could do. We had to save the person. We did everything at the highest level,” surgeon Valentin Filatov was quoted as saying by REN TV. 

According to the ministry, when the fire broke out on the roof,  128 people were immediately evacuated from the hospital, which is extremely old. There were no reported injuries.

“The clinic was built more than a century ago, in 1907, and the fire spread like lightning through the wooden ceilings of the roof,” the ministry said. The fire was believed to have been started by a short circuit. The hospital is the only one in the region with a specialist cardiological unit.

“A bow to the medics and firefighters,” said the local regional governor, Vasiliy Orlov.

Source: Reuters

Categories : Injury & Trauma Neurology Pain ManagementTags :

New Surgery Improves Prosthetic Use and Reduces Pain

On By ModernMedia

A new type of surgery that links muscles together may improve the precision of prosthetic use and also relieve pain.

In typical amputations, the muscle pairs (such as triceps and biceps) that work together to control the joints are severed. However, an MIT team has discovered that reconnecting these muscles that are in an agonistic-antagonistic (‘push-pull’) relationship improves the sensory feedback and thus precision of the affected limb.

“When one muscle contracts, the other one doesn’t have its antagonist activity, so the brain gets confusing signals,” explained Srinivasan, a former member of the Biomechatronics group now working at MIT’s Koch Institute for Integrative Cancer Research. “Even with state-of-the-art prostheses, people are constantly visually following the prosthesis to try to calibrate their brains to where the device is moving.”

The 15 patients who received the AMI surgery were able to flex their prosthetic ankle joint with more precision than those without it, who were only able to fully extend or flex their joint.

“Through surgical and regenerative techniques that restore natural agonist-antagonist muscle movements, our study shows that persons with an AMI amputation experience a greater phantom joint range of motion, a reduced level of pain, and an increased fidelity of prosthetic limb controllability,” says Hugh Herr, a professor of media arts and sciences, head of the Biomechatronics group in the Media Lab, and the senior author of the paper.

The surgery also had a completely unexpected benefit: the reduction of pain in the amputated area, which can be from neuromas or phantom limb pain. Phantom limb pain can occur in 80% of amputess. Six of the 15 AMI patients reported zero pain. This may be significant as in the five centuries since phantom limb pain was first described, there has not been much advancement in the understanding of it.

“Our study wasn’t specifically designed to achieve this, but it was a sentiment our subjects expressed over and over again. They had a much greater sensation of what their foot actually felt like and how it was moving in space,” Srinivasan says. “It became increasingly apparent that restoring the muscles to their normal physiology had benefits not only for prosthetic control, but also for their day-to-day mental well-being.”

To treat patients who had received the traditional amputation surgery, the team is also working on using muscle grafts to create a ‘regenerative AMI’ procedure that restores the effect of agonist and antagonist muscles.

Source: Medical Xpress

Journal information: Shriya S. Srinivasan el al., “Neural interfacing architecture enables enhanced motor control and residual limb functionality postamputation,” PNAS (2021). www.pnas.org/cgi/doi/10.1073/pnas.2019555118