Surgury rotation retractor nonsense

[toothless rufus]

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Whoops, meant surgEry. What's this about holding retractors for hours on end? This really happens? That's useless.

 

[UCLAstudent]

It's NOT useless. Boring, yes, but somebody's got to do it.

 

[toothless rufus]

It's NOT useless. Boring, yes, but somebody's got to do it.

Ok, fair enough. But aren't there little devices that could be used? Honestly, I am worried about being able to stand there holding that position for hours and hours and maybe screwing up or something!

 

[BigRedBeta]

Are there devices to save medical student's arms? Yes. But obviously they're not as adaptable as a medical student. Surgeons can tell you what to do and you'll change tension, angle, and position in second, rather than having to adjust and unscrew/rescrew the mechanical retractors.

Don't worry about screwing something up...the surgeons will direct you to move and adjust as they see fit.

 

[EternalMD]

retracting is not all that bad. It usually means you're right next to the surgeon looking in at whatever they're doing. Most often the put the retractor in the right spot and then have you hold it. If they feel the need to move it, they will re-adjust and hand it back to you.

but thats not all you get to do. I've been on surgeries helping by clipping things or moving the scope around, suturing (albeit, not a lot because the nurses/anesthesia get annoyed because it's a slow go). Hell, I even got to do part of a BKA!!! it all depends on the attending and about being at the right place at the right time with initiative

 

[SoCuteMD]

Don't worry about screwing something up...the surgeons will direct you to move and adjust as they see fit.

What you meant to say is: "Don't worry about screwing something up - you definitely will!"

 

[Hurricane95]

It can get a bit tiring but it really is pretty cool, seeing as how you are right there and working close to the patient. On thursday I scrubbed in on a case that was a full neck dissection to remove metastatic medullary thyroid carcinoma and it was pretty badass, since it was the attending, a fellow and me, the only three working right on the patient. I answered all their anatomy pimping correctly and got lots of face time too; it was a 7 hour procedure almost. Was it tiring? yes...by the end I couldn't feel my feet and lower back, and my thumbs were actually bruised underneath the nail from squeezing down on the army-navy retractor for hours (that SCM muscle is a tough one!). I also had the weirdest cramp in my lats from holding my arm in a weird upwards, outwards position

Yesterday I ran the camera on 2 complicated lap choles and that was tough because at least when you are retracting you can lean back or shift your feet without disturbing them, but with the camera every time you twitch or shift form one foot to the other the whole field of view shakes, to which the attending immediately replies "steady camera please!" That one gave me cramps!

 

[UCLAstudent]

but thats not all you get to do. I've been on surgeries helping by clipping things or moving the scope around, suturing (albeit, not a lot because the nurses/anesthesia get annoyed because it's a slow go). Hell, I even got to do part of a BKA!!! it all depends on the attending and about being at the right place at the right time with initiative

Very true. It also depends on how thinly your team is stretched. I remember rotating through plastics, and on one busy night, there were three cases going on at the same time, with one attending supervising them all --- so it was just the R5 and I in one room. I got to do so much! 😀

 

[UCLAstudent]

What you meant to say is: "Don't worry about screwing something up - you definitely will!"

 

[futuredo32]

but thats not all you get to do. I've been on surgeries helping by clipping things or moving the scope around, suturing it all depends on the attending and about being at the right place at the right time with initiative

I totally agree. I felt like a lot of the attendings let me do more of the "fun stuff" after I had retracted during a long/longer surgery. It was kinda like the pay off.

What you meant to say is: "Don't worry about screwing something up - you definitely will!"

This is pretty true. One of my attendings said to me "there are only two ways a medical student knows how to cut the suture, either too long or two short, you seem to have mastered both."

 

[PeepshowJohnny]

The trick to retracting (in my opinion) is avoiding the hand cramp. I can stand just fine, my arm and forearm get tired but man my hand muscles do. The trick is to learn how to change the way you're holding the retractor(either one or two handed) without losing what you're retracting if you're going to be retracting in the same position for an extended period of time.

 

[Ashers]

Generally, if the residents/attendings like you and can tell you're working hard, that's when they reward you with stuff like suturing, cutting out an appendix, using the GIA stapler thing, and if you're on ortho (putting in traction pins, hammering in nails, drilling, etc).

I had a fellow stick up for me once with suturing on a weekend case during CT surgery. The nurses started to fuss, and he was like, "Don't worry, she's good and fast."

 

[haveaniceday]

as mentioned, retracting can often put you at a better vantage point, so it is not that bad.

The worst retraction experiences are vaginal hysterectomies and breast cases...you see nothing and it is painful. Literally painful, or maybe I just need to spend more time in the gym? 😳

Oh well, never again! Even though I loved surgery...I chose another specialty. I hope I don't regret it.

 

[noentiendo]

I always thought the worst days were where I scrubbed in on 3 mastectomies in a row. Having to hold like 6-7 alices with a lot of tension straight up into the air from across the patient was awkward, and painful after a few hours.

 

[Strength&Speed]

hurricane who is that girl and where can i meet her.

 

[PeepshowJohnny]

vaginal hysterectomies

Simply the worst cases to scrub in on I ever encountered. The position is unnatural and your vantage point is absolutely atrocious. One of the OB/GYN first year residents made me laugh when the attending was pimping him during a case and he was getting stuff wrong.

Attending: "You don't know this, and you've seen how many [vaginal hysterectomies]?"
Resident: "Well, I've been to quite a few but never really seen all that much"

 

[Blade28]

I always thought the worst days were where I scrubbed in on 3 mastectomies in a row. Having to hold like 6-7 alices with a lot of tension straight up into the air from across the patient was awkward, and painful after a few hours.

Agreed that that's painful.

(BTW, they're called Allis clamps. 😉 )

 

[Law2Doc]

as mentioned, retracting can often put you at a better vantage point, so it is not that bad.

Agreed. Scrubbed in and retracting usually means you get to see what's going on. The worst times in the OR are where you have to be there but can't see squat. You can only twiddle your thumbs for so many hours before you go nuts.