Why don't surgeons sit down and operate???

[SomeSurgeryDoc]

So I'm standing with a surgeon in the OR, and he's not moving his legs at all for God knows how many hours. Then this spark of genius strikes my mind. Why don't surgeons just sit down on a stool or something and operate, instead of standing up and not moving a bit, I ask. And to that inquisitive question, I open this thread for the world of student doctors to dwell upon...

---

Members don't see this ad.

 

[deleted109597]

Some do. But most intraabdominal surgeons do not.
Why? History.

 

[velo]

yeah, I've seen hand surgeons sit down a fair amount, or other surgeons when working in a small area on an extremity. But when you're leaning over the patient to do see the field or you're working in a larger area sitting down would just mean constantly readjusting your position and possibly contaminating yourself each time.

I agree though, I hated standing for so many hours at a time on surgery rotations.

 

[kypdurron5]

I shadowed a neurosugeron. He stood for most of the procedure, but sat down once he actually started frying brain tissue. I really think it's a matter of position and convenience and not at all about tradition.

 

[IllKeepDigging]

i'm not completely sure, but i believe there may be some issues with compromised sterility

 

[Abilene85]

Could you sit and dissect in anatomy lab? I always tried, but unless I was working on the forearm/hand, I felt like I couldn't see well. I assume surgery is similar.

 

[PreMD86]

Ever seen the Seinfeld episode where Constanza buys the security guard at his fiance's uncle's clothing store a chair? That's why.

 

[smq123]

So I'm standing with a surgeon in the OR, and he's not moving his legs at all for God knows how many hours. Then this spark of genius strikes my mind. Why don't surgeons just sit down on a stool or something and operate, instead of standing up and not moving a bit, I ask. And to that inquisitive question, I open this thread for the world of student doctors to dwell upon...

Some of the ENT guys do, at least for short cases. Any microvascular surgery - you'll need to sit for.

But there are definitely issues with compromising sterility when you're working in the abdomen. You'd need to keep your arms at shoulder length - which is the upper limit of your sterile field. You'd be bringing your (unsterile) mask close to the sterile field on the patient.

You're not the first to come up with this "spark of genius." It's just, sadly, not a viable "spark of genius." 🙁

 

[kypdurron5]

Ever seen the Seinfeld episode where Constanza buys the security guard at his fiance's uncle's clothing store a chair? That's why.

As soon as I saw "Seinfeld" I thought it was going to be a Junior Mints episode reference >).

 

[Blade28]

As soon as I saw "Seinfeld" I thought it was going to be a Junior Mints episode reference >).

That's what I thought! But the security guard episode is a good thought as well.

Mainly we don't do this because of problems with maintaining a sterile field (as noted above). Sometimes it's done - especially with microvascular (e.g. flaps) work in Plastics/ENT, AV fistulas in Vascular, etc. But with your hands so much closer to your face (and near shoulder-height, which as smq123 stated above is the upper limit of your sterile field) there's just so much more potential for contamination. This is one of the reasons why we always discourage med students from bending over when suturing, even if it affords a closer view that way - you just don't want your (unsterile) mask that close to the field.

Additionally, sitting on a stool means you're less mobile - in many cases you constantly have to change positions - this can be cumbersome enough just using stepstools, so imagine how much harder it is with regular stools.

 

[njbmd]

Moving to the surgery forum where surgeons can answer this question.

 

[Pir8DeacDoc]

As mentioned above we will sit during our flaps and also during our ear cases or tonsillectomies. Otherwise you just can't see what the hell you're doing.

Are people really getting so close to the patient with their mask that they risk contamination? WOW. If it makes you feel better, the wound is probably already colonized anyways.

 

[Winged Scapula]

Heck, it was one of the reasons I seriously considered doing Hand.

I think I might have to operate sitting down tomorrow because I was walking all over Times Square last week during a conference and my feet are still sore. I don't think the hospital will let me. 🙁

Anyway, nothing further to add, other than my own woes.

 

[Kubed]

Could you sit and dissect in anatomy lab? I always tried, but unless I was working on the forearm/hand, I felt like I couldn't see well. I assume surgery is similar.

Actually, learning how to sit and dissect was one of the highlights for anatomy, at least for me. We had tall stools that you could kind of lean/stand against. Those were happy days once we figured that out

 

[njbmd]

I actually hate to sit and operate. I feel like I can't see as well. I do sit for hand and forearm work (fistulas) but wind up standing for about half of those. When I am standing, I find myself fidgeting and shifting which keeps the circulation going.

To Winged Scapula: Birkie Bostons! You can slip your feet in and out and get some relief when they are sore. Good time for a pedicure and foot massage too!👍

 

[Castro Viejo]

I think I might have to operate sitting down tomorrow because I was walking all over Times Square last week during a conference and my feet are still sore.

... Or was it running away from the boogie (wo)man?

 

[Winged Scapula]

I actually hate to sit and operate. I feel like I can't see as well. I do sit for hand and forearm work (fistulas) but wind up standing for about half of those. When I am standing, I find myself fidgeting and shifting which keeps the circulation going.

To Winged Scapula: Birkie Bostons! You can slip your feet in and out and get some relief when they are sore. Good time for a pedicure and foot massage too!👍

Ughh...I'd rather operate in Manolos than Birkenstocks, no matter how much my feet hurt.

Sorry, but give me some glamour over comfort any day.😀

 

[Winged Scapula]

... Or was it running away from the boogie (wo)man?

probably that too...

 

[Blade28]

To Winged Scapula: Birkie Bostons! You can slip your feet in and out and get some relief when they are sore. Good time for a pedicure and foot massage too!👍

Ha ha, awesome!

Are you still wearing cowboy boots on the wards? 🙂

 

[kevster2001]

Too high or too low and you put the patient out of the sterile field.

 

[DrDre311]

If you're doing a procedure where you need to readjust your angle, then sitting isn't really the greatest option. Ditto for leaning over further, or holding up heavy things where you need leverage.

I think sitting is awesome (unfortunately, Hand is not). But I can't imagine trying to do a THA with the team parked on a chair.

Incorrect!

Hand is awesome.

Free tissue transfers are also great.

 

[Strength&Speed]

Christ, you're right. And here surgeons have been standing all these years and never thought to sit down.

thank you sdn

 

[Strength&Speed]

😛 I'm just kidding by the way. Good thread.

 

[DrDre311]

Hand is not awesome. Hand is tolerable at best. Any field that uses retractors so small that they can only be found while wearing loupes is, by definition, not awesome.

Free flaps are awesome, but you don't have to do Hand to learn them.

pfffft! Hand is great. Short cases (except replants/crazy work accident stuff), you get to sit down while you operate...good stuff. Plus, the hand is so elegant--so many moving parts, so intricate, everything with a defined purpose. And have you ever done a replant? Awesome. Not to mention tendon transfers, plus all the cool flaps: Kutler flaps, Kite flaps, Moberg flaps, neurovascular island flaps, Littler flaps, etc...so cool! I could go on.

 

[DrDre311]

Only for chronic masturbators.



This is not a good thing. Shorter cases means more time for clinic.



That's because falling asleep while you're operating is dangerous unless you have a chair under you.



Yes, elegant when it's healthy. When it's not healthy (like when it needs an operation) it is a pound of bloody scar tissue crammed into the volume of a chicken egg.



No, I haven't. But it does seem awesome. I'll give you this one.



If you love hand that much, why not go do a plastics fellowship? You can do your replants and flaps, plus you get boob training.

Personally, I chose Ortho because I believe in maximally invasive surgery. No hand, no sports, thank you very much. Give me a THA or tibial nail any day of the week. If I wanted to spend all day throwing tiny sutures, I would have gone into Ophtho or Gen Surg.

I thought about this question as a medical student. That is why I am a plastics resident at this very moment.

 

[DrDre311]

Only for chronic masturbators.



This is not a good thing. Shorter cases means more time for clinic.



Yes, elegant when it's healthy. When it's not healthy (like when it needs an operation) it is a pound of bloody scar tissue crammed into the volume of a chicken egg.

No, it means more cases on surgery days.

Also, Dupuytren's is not the only indication for a hand operation.

 

[njbmd]

Ha ha, awesome!

Are you still wearing cowboy boots on the wards? 🙂

My back-cut pythons are still serving me well and comfortably. 👍

 

[roja]

Ughh...I'd rather operate in Manolos than Birkenstocks, no matter how much my feet hurt.

Sorry, but give me some glamour over comfort any day.😀

😍 I knew I liked you for some reason. Of course, why you were wasting your time walking around times square is beyond me. 😉 The east village is much more fun.


When I do appy's in the ED...... never mind.

 

[DrDre311]

Congrats on the size of your sack. I gave some thought to Plastics, but at the end of the day the competition for the Integrated spots (plus the question of if the military would even let me go that route) swayed me away.

At this point, all I want to do is pound bone and throw screws and make other pseudo-sexual references to really cool surgeries, so I'm glad with my choice.

But I'll tell you, after my month on plastics doing primarily cosmetic cases, I almost wished I had gone that route instead.

Thanks. It's worked out well so far.

I also was set on ortho as a med student...loved it, until I did some hand cases, and realized if I went into plastics I could do flaps all over the body. That, plus the boob training. After that I was sold.

Also, I've never thought of it before, but I wonder how the military would feel about letting someone do integrated plastics?

 

[Winged Scapula]

😍 I knew I liked you for some reason. Of course, why you were wasting your time walking around times square is beyond me. 😉 The east village is much more fun.

My conference was at the Marriott in Times Square and the way surgical conferences are, what with starting at 0630 and ending at 1930, there isn't much time to go anywhere else. I did manage a dinner out in Soho though.

 

[Castro Viejo]

The east village is much more fun.

The East Village? Alphabet City? Nasty...

Down there, I'd much rather spend my time walking around Soho, Greenwich Village, and the West Village. I try not to go beyond the Bowery or Second Avenue. 🙂

 

[roja]

The East Village? Alphabet City? Nasty...

Down there, I'd much rather spend my time walking around Soho, Greenwich Village, and the West Village. I try not to go beyond the Bowery or Second Avenue. 🙂

Except for the fact that the best tagines and turkish coffee are in the east village. 🙂

The problem with soho, greenwich and the west village are all the tourists.😱

 

[Castro Viejo]

The problem with soho, greenwich and the west village are all the tourists.😱

The problem with the East Village is all the riff-raff and the hoodlums.

No thank you. If I wanted to hang with people who don't shower on a regular basis and who would rob me blind given the chance, I'd head on over to the my old stomping grounds in East Flatbush, Brooklyn.

 

[roja]

The problem with the East Village is all the riff-raff and the hoodlums.

No thank you. If I wanted to hang with people who don't shower on a regular basis and who would rob me blind given the chance, I'd head on over to the my old stomping grounds in East Flatbush, Brooklyn.

sorry. seriously hijacked thread.

Even in the ED, I only sit to sew if its on the hand. Otherwise, I adjust the bed to avoid killing my back and stand. And I don't have all that messy sterile stuff to think about. 😉

 

[Plastikos]

Hand is not awesome. Hand is tolerable at best. Any field that uses retractors so small that they can only be found while wearing loupes is, by definition, not awesome.

Free flaps are awesome, but you don't have to do Hand to learn them.

You dont have to do any hand in your Ortho residency? That would be strange. Im not a huge fan of hand, mostly because of the q2 call and how it can totally crush you at times. Sure, replants can be neat, in moderation...but get a couple in a row or a couple days of all night replants (we do all replants) and all day regular work and they lose some luster.

On sitting, I guess ive never worried about sterile field or being too close to my face, it seems you have a crappy stool if this is a real problem. Not that i think it would be anything but cumbersome in big abdominal cases, its not right for everything.

 

[DrDre311]

Yeah, I bet you guys get a lot of crazy work accident stuff/farming accidents/replants down in Temple. How many replants would you say you guys do in an average month?

 

[Pir8DeacDoc]

Dude, anything q2 call sucks, even if you're not operating all the time. Just being there sucks the life out of you . . .

Not to disagree with call in general sucking but I think PRS is almost always home call. In fact, I seem to recall that at Scott & White (if that is indeed where Plastikos is -- someone above mentioned Temple) the general surgery interns not on trauma take home call. So yes, Q2 sucks but not as bad if you can at least do it mainly from home.

 

[DrDre311]

You could take call from anywhere within Temple city limits and it would take the same amount of time to get to the ER as it does from a call room.

 

[Plastikos]

Not to disagree with call in general sucking but I think PRS is almost always home call. In fact, I seem to recall that at Scott & White (if that is indeed where Plastikos is -- someone above mentioned Temple) the general surgery interns not on trauma take home call. So yes, Q2 sucks but not as bad if you can at least do it mainly from home.

This is true. Part of the beauty and pain of it all. Overall, i much prefer home call , even if its terrible, there are those good days where youd be stuck at the hospital for no good reason.

Tired, I guess I disassociate free flaps and hand surgery for the most part, and by no means think it possible to know hand just from residency.

We do get a fair number of replants, but i would be totally guessing if i tossed a number out.

 

[DrDre311]

Through this year, I have never been on a rotation where home call was remotely feasible. I have never covered just one service at night, and I have not been able to get more than 3hrs uninterrupted sleep, even on the slowest services. Amazing that interns anywhere could be able to do home call; even more disturbing that it promotes "not going to see the patient" during the year where you absolutely should not be trusted to blow off nursing calls with a quick phone order.

Ever been to Temple? A 5 minute radius from the hospital encompasses Temple in its entirety. Taking home call for you would probably be like a S&W resident taking call from a hotel room in Austin. Although you're absolutely right about the danger of blowing off nursing calls.

 

[Pir8DeacDoc]

Through this year, I have never been on a rotation where home call was remotely feasible. I have never covered just one service at night, and I have not been able to get more than 3hrs uninterrupted sleep, even on the slowest services. Amazing that interns anywhere could be able to do home call; even more disturbing that it promotes "not going to see the patient" during the year where you absolutely should not be trusted to blow off nursing calls with a quick phone order.

I agree with all of this.. It's an interesting setup. But it seems to work well for them.

Temple is small but I really like it. Crazy cheap living and close to Austin!

 

[Plastikos]

Through this year, I have never been on a rotation where home call was remotely feasible. I have never covered just one service at night, and I have not been able to get more than 3hrs uninterrupted sleep, even on the slowest services. Amazing that interns anywhere could be able to do home call; even more disturbing that it promotes "not going to see the patient" during the year where you absolutely should not be trusted to blow off nursing calls with a quick phone order.

The thing is u do go to see the patient quite often, obviously much more during the first year of course. It probably makes a huge difference covering only one service at a time, allowing you to know your patients a little better than covering patients u may have never met. Though many will keep u up all night, and some in the er every night. There have been months on home call where 3 hrs of interrupted sleep would have been deemed a good night if that was all u got.
As has been mentioned, there is not a whole lot of difference between home call and being in house in our particular set up. Except for the obvious luxury of fielding calls in the comfort of your home instead of the callroom.
Lots of things seem unreasonable or impossible until they are done, we are definitely not the only place where this occurs, and the patient care does not suffer most importantly.