Most of the time, when we start our Operating Room training, we start out in General Surgery. And rightly so, because it is a diverse field that covers a wide array of surgical specialties and body systems. This makes it a great place to begin because it allows us to become well-versed in a variety of practices. From patient positioning to unexpected procedural changes, General Surgery demands a comprehensive level of understanding and preparedness. So today, as a refresher for some, and as an intro for others, we're going to delve into the world of General Surgery with our Top 10 list.
1. General surgery covers a wide variety of surgical specialties and body systems.
Colorectal, thyroid, abdomen, cysts and lipomas, ports, head and neck, breast. The list can go on! Due to multiple sub-specialties this list will cover a broad spectrum of information that can be used in all sub-specialties.
2. Be prepared to convert from laparoscopic to open procedures.
Things can change in an instant when performing any laparoscopic surgery. The team always needs to be ready to convert to an open procedure if the even arises. Always have the supplies and instruments in the room so you are not rushing around wasting time if you need to convert quickly.
3. Understand patient positioning.
Due to the variety of surgical specialties under this umbrella, patients may be placed in a variety of position depending on the surgery and part of the body being operated on. Have all positioning aids available to properly and safely position the patient to provide the best care. This includes, but is not necessarily limited to, foam, gel rolls, shoulder rolls, stir ups, beanbags, and sleds.
4. Know your implants!
Many of these cases will require implants such as ports, mesh, catheters, or patches. Ensure the integrity of the package is in good condition and not tampered with and confirm expiration dates prior to opening to the field.
5. Colorectal surgery has pioneered the ERAS pathway (Enhanced Recovery After Surgery)
Incorporating this plan will help patients return to pre-operative function more quickly. It is a multi-disciplinary bundle to improve patient care. In addition to basic surgical care, this bundle incorporates early removal of catheters and NG tubes, not using drains, and allowing for clear liquids 2 hours before surgery. It’s important to know what’s included in the bundle so the patient can receive proper care top optimize outcomes.
6. With a variety of surgical specialties comes a variety of dressings...
From the simple 4x4 gauze and tape to binders, to bras, to glue, make sure you have the proper dressing to ensure proper support and wound healing.
7. Prevent adhesions!
There are many products out there to help prevent adhesions. Adhesions can form in the peritoneum after abdominal surgeries (both open and laparoscopic). They can result in complications in the post-op phase including pain and obstruction, which can lead to further surgery. Make sure you’re using appropriate products for the patient.
8. Be prepared for bleeding and know how to help control it.
But there are ways we can control it. Besides blood products there are a wide variety of hemostatic agents that can be used to stop bleeding and form clots. Be sure to read the IFU (instructions for use) on the products. Not all agents can be used in all surgical cases. Some are contraindicated.
9. Know your labs and pathology requests!
Sometimes intraoperative labs and pathology requests are needed to proceed with surgery. Parathyroid cases need intraoperative PTHs to see if they are getting the affected area. Colon cases may send of frozen sections to get a confirmation of a cancer diagnosis. Intraoperative tests should be discussed with the team before surgery begins so that you can be prepared with specimen cups, pathology request forms, and tubes for blood work.
10. Maintain your drains.
Drains allow for an exit of air, fluid, blood, lymph, secretions, bile, and pus from the operative site. They can also be used for wound infection prevention. There are a variety of sizes and types so double-check which one is best for your patient post-operatively. Document the type and location of the drain and ensure it is patent before leaving the OR.
General Surgery is an ever-evolving, general specialty that requires adaptability and a broad understanding of surgical practice. As we've explored ten important things about this specialty, it's evident that versatility and preparedness are paramount. Whether it's mastering patient positioning, ensuring the integrity of implants, or preventing complications like adhesions, each element contributes to the overall success of a surgery.
Moreover, embracing innovative approaches like the Enhanced Recovery After Surgery (ERAS) pathway exemplifies our commitment to improving patient outcomes. Recognizing the significance of intraoperative labs, hemostatic agents, and proper drain maintenance further underscores the complexity and precision required in the OR.
General Surgery is very broad and encompasses so many different aspects of surgical care. But, with proper preparation and attention to detail, we can master this specialty and continue making a difference in our patients' lives.
Keep up the great work,