Another development that is being scientifically supported by The New European Surgical Academy (NESA) is a European robotic system called Telelap Alf-X, which allows the surgeon to indirectly “feel” the tissues they are manipulating during surgery. The system is already certified in Europe and more than 100 clinical studies are under way. Experts are predicting that many new surgical robots, which will enable the sense of touch, will become available. The additional market competition should help bring down the cost of robotic surgery.
Training to Save Costs
Speaking of cost, Berkley recommends that hospitals begin looking at education and training as an investment rather than simply an expense. Despite reports that claim that hospitals profit from some errors, repeated surgeries and residual damage from poor surgeries have been shown long term to be quite expensive for both patients and hospitals, with cumulative annual estimates nearing $1.5 billion.1,2 In the United States, it's been reported that patients undergoing surgery experience "never events" about 80 times each week—mistakes that safety advocates say never should happen.3 These mishaps add up to $1.3 billion in medical liability payouts alone over 20 years. The study’s surprise was the conclusion that surgical errors involve surgeons of all experience levels.
The advantage of practice on the simulators and mentored cases is improved OR performance that prevents these costs. Studies are showing that simulation testing can help hospitals gauge whether a surgeon is ready for the OR. Such a proactive approach can be more cost effective than reacting only after a surgeon makes a mistake. Much of the new, independent rules that hospitals are implementing now require more training such as this. It appears that administrators are listening to the argument that quality of care and costs are associated.
Team Approach for Training
The other important area of training is through teamwork. “Depending on the case, if there is damage to the colon, for example, I may want a general surgeon with me in the OR because it is not my normal expertise," says Melinda Henne, MD, former head of infertility at Walter Reed and a consultant for the Air Force. Richard Satava, MD, a general surgeon and Professor Emeritus of Surgery at the University of Washington, Seattle, agrees that bringing on either a generalist or a specialist helps a great deal with training. “If there is an area the gynecologist feels uncomfortable with, we can be helpful,” he says. “The ureter can be unfamiliar, the kidneys, the bladder. But the colon is a particularly uncomfortable area for many GYNs because if you injure the bowel and there is leaking, it can be catastrophic.”
Satava also mentions that with the trend of super specialization there is less and less emphasis on the role of the general surgeon. But since they operate so often and have very broad experience in the many aspects of abdominal surgery, it can be quite helpful to include them as partners in the OR. “This is a time when there are more requirements and pressures on specialists. And, at the same time, there are fewer hours of experience for newer surgeons. In anticipating a difficult operation, there is no question that a general surgeon will increase the quality of the surgery and the safety for each patient.” And it’s not just a general surgeon. Satava also recommends specialists, “You may want to include a urologist in the room.”
As a surgeon, I know firsthand that when implementing this team-based approach, it is important to ensure that all members are equally skilled in their areas of focus, otherwise the whole process breaks down. For example, if the colorectal surgeon is not competent at managing bowel endometriosis, then the work performed by the infertility specialist is compromised and patient outcomes are impacted.
Patients such as Lindsay have come to learn that for tough surgeries, a better-trained surgeon is essential.
1. Encinosa WE, Hellinger FJ. The impact of medical errors on ninety-day costs and outcomes: an examination of surgical patients. Health Serv Res. 2008;43:2067-2087. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613997/. Accessed August 27, 2014.
2. Cabrera M, Cavanaugh M, Pico P. How hospitals can avoid surgical mistakes. March 1, 2013. Available at: http://www.kpbs.org/news/2013/mar/01/how-hospitals-can-avoid-surgical-mistakes-do-not-p/. Accessed August 27, 2014.
3. Mehtsun WT, Ibrahim AM, Diener-West M, et al. Surgical never events in the United States. 2013;153:465-472. doi: 10.1016/j.surg.2012.10.005. Epub 2012 Dec 17.