Friday, July 6, 2012

Ask Skeptical Scalpel-Learning Surgical Skills

Medical student Sara@Stichflamme asks, “What exercises such as suturing and other skills can I do to prepare for a career in surgery?

I have always felt that more important than technical skills are knowing both whom to operate on and when. I’m reminded of a blog I wrote in November of 2011 called “I could teach a monkey to operate.” I pointed out that this cliché has been around for a long time, but so far, there are no reports of a monkey successfully operating.

At one time, applicants to surgical residencies had to pass dexterity tests such as carving something from a block of soap or making a model airplane. I know of no program that still requires such activities.

By the time you finish training, many operations may be robot-assisted. Surgical robots purportedly eliminate tremors and facilitate precise dissection. Devices such as the Ligasure have revolutionized both open and laparoscopic surgery and reduced the need for tedious knot-tying. Staplers for organs and skin have almost eliminated sewing. We even have looped and barbed sutures that don’t require knot tying skills to secure.

I posted a version of this on Sermo yesterday. All of the commenters felt that skills such as knot tying will be necessary for the foreseeable future. However, I can think of many common minimally invasive procedures that can be done without tying a single knot.

The consensus was that a budding surgeon should learn to tie knots and sew. A study showed that surgeons who played video games performed better at laparoscopic skills than those who didn't play video games. This is hardly proven but you would be surprised at how many people believe it.

Bottom line: Practice knot tying on the bedpost until you can do it quickly and smoothly with your eyes closed. I suggest using string or even clothesline at first so you can see how the knots are formed. Regarding video games, I defer to “docpark” on Sermo who said, “I would have to add that not all video games help. 1st person shooters not as good as a 3rd person games, and classic games are best. I recommend Defender, Asteroids, or it's iOS update Meteor Blitz.” I trust you will know what that means.

Good luck.


Fruttel1 said...

Even tho I wouldn't expect anything less from you, it still pleases me you wrote "robot-assisted surgery".
I am amazed (and often annoyed) at hów many people here in the Netherlands(medical personnel included) still call it 'robot-surgery'.

Skeptical Scalpel said...

Fruttel1, I agree. Many people think the robot operates by itself. As you correctly note, it simply is a tool to help the human surgeon perform the procedure.

Thanks for bring such a faithful follower.

Anonymous said...

There are those coming out of training now who have only done a handful of "open" surgeries. Laparoscopic surgery is amazing but you still need to know "how to" do the surgery. Robotics are still in the infancy stages. The more technical we get the more things can go wrong.

Skeptical Scalpel said...

I agree. A commenter on Sermo said he heard that fellowships in "open surgery" may be on the horizon. But where is a hospital that has sufficient open surgery volume to support such a fellowship?

Anonymous said...

Maybe a combined Trauma Surg/Open surgery fellowship? (haha). I mean, half of the open surgeries I've seen are the result of something going wrong anyway. Trauma centers may end up the only place with the necessary volume to train in open surgery.

SeaSpray said...

Hi Skeptical Scalpel - Do the robots ever break down? What happens then? Could they be affected by power outage? I know hospitals have backup generators, but I'm thinking of the surgeon who had to operate last summer with someone holding a flashlight while the tornado was decimating the hospital.

Shouldn't all surgeons be proficient in open surgery?

Skeptical Scalpel said...

Anon, even trauma centers do not have enough open surgery volume. The new specialty "Acute Care Surgery" was invented so that trauma surgeons could actually do surgery.

Sea, I assume, like all computers, robots can malfunction. And yes, power does fail on occasion. I agree all surgeons should know how to do open surgery. The next generation of surgeons may be deficient in this area.

Henry said...

It has been a challenge for surgeons who are well versed in established surgical procedures to transition to robotic assisted surgery. I am concerned by the urgency with which some surgeons feel a need to commence robotic assisted surgery - it is the patients who suffer for such haste. I plan to keep a record of my personal experience with transitioning to robotic assisted radical prostatectomy.

btw - i am really enjoying your blog and twitter feeds @DrHenryWoo

Skeptical Scalpel said...

Henry, I agree keeping a record of your experience is a good idea. Thanks for following me.

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