Length of time spent in the operating room?

[siimpleton]

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I was wondering if anyone could comment on the length of time spent in the operating room in different surgical specialties. I am starting 3rd year and have some difficulties with standing in one place for extended periods of time (more than 10 minutes) I am trying to resolve this, but in case I can't I'd like to choose my surgery electives to be the areas that have the least amount of time spent in the OR and/or the specialties with the shortest surgeries. My options for electives include: Opthamology, Urology, Orthopedics, Vascular, Neuro, and ENT.

On a side note, if anyone has any ideas on how to keep from getting lightheaded I'd appreciate it. Has anyone tried compression stockings for lightheadedness or back supports for lower back pain? Thanks!

 

[siimpleton]

I was wondering if anyone could comment on the length of time spent in the operating room in different surgical specialties. I am starting 3rd year and have some difficulties with standing in one place for extended periods of time (more than 10 minutes) I am trying to resolve this, but in case I can't I'd like to choose my surgery electives to be the areas that have the least amount of time spent in the OR and/or the specialties with the shortest surgeries. My options for electives include: Opthamology, Urology, Orthopedics, Vascular, Neuro, and ENT.

On a side note, if anyone has any ideas on how to keep from getting lightheaded I'd appreciate it. Has anyone tried compression stockings for lightheadedness or back supports for lower back pain? Thanks!

Although I am very concerned about this, I can't resist adding this peice of humor. I have this recurrent image, that on the first day of my rotation, 10 minutes into the surgery I pass out and the surgeon looks up and starts singing, "Another one bites the dust."

 

[MirrorTodd]

If passing out is your concern, then make sure to stay very well hydrated. Also, don't lock your knees, keep them slightly bent. You could try bending alternating knees or fidget very slighty to keep yourself movng. This is a big issue for me as I'm in the military and we regularly stand in formation for long periods. I've only passed out once and that was because I had no water that day and it was 90 degrees out. As for your question, I have no clue about operating times, sorry.

 

[sacrament]

I've got flat feet, and my surgery rotation was an absolute nightmare. I never once felt like I was going to pass out, but I had constant pain. An hour into a case and my feet would be aching. Two hours in and my feet would be on fire and my lower back would be screaming. Three hours in and I would be constantly shuffling my feet, shifting my weight, stretching my back... at the end of every day I'd have to soak my feet in hot water for an hour while snarfing an unhealthy dosage of ibuprofen. I tried the recommended shoes, the recommended posture, the recommended compression stockings... nothing really seemed to help much. This post isn't particularly helpful or reassuring, sorry.

 

[MR1]

For length of surgery ophthalmology would be the best, most surgeries are 15 min to 1 hour, some retinal surgeries can go 2 hours though but that is not the norm. I would for sure avoid neurosurg their surgeries are some of the longest. The rest vary greatly, I did some ENT surgeries that were only 1-2 hrs but also did a few that went 6+ hours. Urology might be a good bet, most were 1-3 hours but again some can go long. Ortho is similar to urology with most averaging 2-4 hours. Sorry I didn't rotate on vascular so I can't tell you about those but I would bet most would be 3+ hours. Hope this helps and good luck. I would second staying hydrated, I'd rather suffer having to pee than pass out. Also you might try eating something small before each case.

 

[mysophobe]

Vascular is very varied. AV fistulas can take an hour, AAAs can take 2-3 or more. The good thing is that AV fistulas, thrombectomies, etc. are all sitting cases. As a med student though, you'd probably stand anyway since the surgeon and fellow would be sitting at the field.

Anyways, do you have to do a surgery "elective" (why is it called elective if it's mandatory?) or are you just interested in it? If you HAVE to do one, I'd pick ophthalmology.

 

[NoSz]

I had the same problem, maybe because I am a pretty tall person. And I passed out twice during my surgery electives, though I always had tunnel vision before contaminating everything. I was surprised how many people faint during surgery. No one really bothered.

Have breakfast. Try to keep well hydrated (don't use coffee, you will die of sudden severe urge to empty your bladder). Use those ugly stockings. Always move your toes. Relax your shoulders. Move your eyes. Try to have good ventilation. Dress lightly and rather feel cold than hot.
Then hope for the best. If you start to feel funny, tell the surgeon and remove yourself from the field.

If you need to faint, you need to faint. Sorry, Sir.

Oh- if possible check the speed of your surgeon, you want to avoid the snails.

 

[Arginine]

Choose ophthalmology! Like MR1 says, most optho surgeries range from 15 min (cataracts!) to about 1 hour. Generally only one surgeon is working on the operating field at a time because it's so small & it requires magnification. You may be able to sit down and watch the surgery on the viewing screen.

As a general rule, you may be able to sit down for many laparoscopic procedures in any surgical subspecialty (to watch on the viewing screen) unless they need someone to hold some of the instruments.

Hand surgery is one of the few specialties where all operating is done while sitting down.

Although most urology surgeries are not much longer than 3 hours, some will last longer. Yesterday I spent 4 hours with a resident on a cystoscopy with many stubborn kidney stones that needed to be fragmented with a laser and painstakingly removed from both sides. Today I was scrubbed in to a 6-1/2 hour radical cystectomy and my feet are killing me... 😱

 

[Nightengale]

Given those choices, Ophtho, second choice probably ENT. NOT neuro or ortho. I don't know enough about the others to comment. I'm just finishing up 3rd year.

I have difficulty standing and need something to hold onto if I'm going to be standing for too long, although I'm OK for up to an hour or so with that support. I had some long discussions with the course director and my doctor about how I was going to get through the surgery requirements. I got permission to do more sitting and observing than usual. I also can't hold a retractor for more than a few minutes.

Last year they had me do colorectal and trauma surgery. Colorectal I did a lot of observing - there were other students on rotation who were going into surgery and so it worked out well. I spent several afternoons in the outpatient clinic. Trauma the surgeries tended to be only an hour or so. I did a fair bit of leaning against the table and holding onto it when I had a spare hand, which got me through the six weeks relatively unscathed. I had more trouble on my feet in OB-GYN than in surgery.

I'm doing ENT and Ophtho for my subspecialties next spring. The Ophtho course director says mostly the students sit and watch on the screen anyway. ENT I'm likely to mostly be observing and I've been promised a lot of clinic time.

Let me know if there's anything else I can answer for you about standing and 3rd year rotations.

 

[Smurfette]

Let me point out that on most inpatient rotations you will be standing for prolonged periods of time (using ~10 minutes as your tolerance level). Medicine rounds if you have an attending who does bedside teaching....well, let's just say you may find yourself standing in the same place for 45 minutes to an hour if your attending's a talker. Surgery obviously has lots of standing in the OR, not so much on the wards though.

If you have medical/physical limitations, tell your residents/attendings beforehand, so it is less likely to be problematic. They likely will try to accommodate you as much as reasonably possible (i.e. giving you the shorter OR cases, allowing you to sit on a OR stool, giving you a break, whatever).

One thing: if you are scrubbed in the OR and feel faint, STEP AWAY FROM THE STERILE FIELD. Passing out is ok (it happens, more often than you think), but not saying anything about feeling ill and then passing out and falling onto the patient is not ok. If you say you don't feel well, the OR nurses will take care of you and help you to avoid contaminating anything.

 

[medulla]

My two cents...
I agree with the above about optho as your first choice. Last choice for your situation should be Neurosurg--most surgeries I scrubbed on were at least 5 hours, the longest one on a Friday night was 10 1/2 hours, I kid you not. Quite honestly, I have no idea how I survived, but I did have a moment of clarity (actually 10 hours of clarity) about my decision not to go into Neurosurg!



Also, not sure if anyone mentioned this, but those support socks for people who have poor circulation (or stand on the job all day) have been a life saver for me. You can get them at a drugstore/supermarket/pharmacy, etc.

Good luck, and again, stay hydrated, eat a solid breakfast and recognize when you can't take it anymore.

 

[Shah_Patel_PT]

Luckily I never fainted....but the longest I had to scrub in was actually during OBGYN where I had 6 hysterectomies I had to scrub in to..that was so tiring..and whats worst...after that... starting at 8 PM I had a 24 hour call. 🙁

 

[babyruth]

For low back pain or flat feet, try some expensive arch supports and they will be worth your money. I wear Dansko shoes in the OR and on the floor and they were hard to break in but have really nice arch supports, but the cushioning for the sole is not as nice. I have been searching for the perfect pair of shoes for a long time and they are hard to find, but they can make a big difference to your back.

 

[njbmd]

Vascular is very varied. AV fistulas can take an hour, AAAs can take 2-3 or more. The good thing is that AV fistulas, thrombectomies, etc. are all sitting cases. As a med student though, you'd probably stand anyway since the surgeon and fellow would be sitting at the field.

Anyways, do you have to do a surgery "elective" (why is it called elective if it's mandatory?) or are you just interested in it? If you HAVE to do one, I'd pick ophthalmology.

Hi there,
I am going into vascular surgery and I do not sit for any cases. I do all of my fistulas, grafts and AAA repairs on my feet. I get better visualization and can shift my body to get the best suture angles. None of my attending sit either.

njbmd 😎

 

[loveumms]

If you’re worried about time on your feet - stay away from transplant. One kidney transplant I had to watch the donor surgery then go into the adjoining room for the recipient. Believe me, it was pure torture.

I lucked out of a liver transplant but, they can run 8+ hours.

I'm so glad that some people like it b/c I know I could never do it (even though it was pretty amazing to see a donor kidney come alive in a completely different person) 😉

 

[siimpleton]

Just to answer some questions that have been posed (I am the one who started this thread)... I do use orthotics (prescription arch supports essentially) and I do recommend them for anyone else with flat feet. Without those I'd be in much worse shape. I think it is probably the flat feet and the back pain that encourages me to stiffen up in to that ideal posture (which helps the back but makes me more lightheaded.) As for the electives, we have 12 weeks of surgery, and apparently part of that is elective as to which specialty we do. I have to rank the specialties 1-6. I've gotten great advice on putting optho first and neuro last. I was just wondering if anyone had an opinion on the others (vascular, ENT, Urology, Ortho) since I may not be lucky enough to get optho (or we may be doing multiple, I'm not really sure.) Thanks again!

 

[loveumms]

are you at UMSOM by any chance?

 

[nabeya]

In general surgery, the average length is usually around 2.5 hours max on one case. But it just depends on what you're doing. With lap choles which you'll see alot of, they can take anywhere from 45 min to 2.5 hours depending on the difficulty of the anatomy. AV fistulas usually about an hour. Colon surgeries are usually the ones that take the longest. You'll probably be doing a few thyroidectomies, mastectomies, inguinal hernia repairs. Those are the ones that you'll see the most in general surgery.

I was wondering if anyone could comment on the length of time spent in the operating room in different surgical specialties. I am starting 3rd year and have some difficulties with standing in one place for extended periods of time (more than 10 minutes) I am trying to resolve this, but in case I can't I'd like to choose my surgery electives to be the areas that have the least amount of time spent in the OR and/or the specialties with the shortest surgeries. My options for electives include: Opthamology, Urology, Orthopedics, Vascular, Neuro, and ENT.

On a side note, if anyone has any ideas on how to keep from getting lightheaded I'd appreciate it. Has anyone tried compression stockings for lightheadedness or back supports for lower back pain? Thanks!

 

[Paws]

Are you guys kidding me???! Neurosurg has like, 10 hour surgeries? great. I just signed up for a rotation as a subspecialty. I have shadowed in the OR for neurosurg and it was great to sort of leave when I wanted, after say, about 8 hours. I know it will be different as an official student and not being able to just split when I had enough. This might be why I am going to be the only student on the rotation and everyone else has gone for ent/urology, cardio, etc.

What was I thinking ... 😱