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| News and Notes
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Surgeons may debate the merits of open surgery versus laparoscopy for a partial colectomy procedure, since both approaches have their advantages. But one answer may lie in combining the benefits of each, which may reduce the amount of time it takes to perform the procedure.
An experimental study comparing hand-assisted laparoscopic surgery, which will combine elements of open surgery with laparoscopy, against standard laparoscopic colectomy is currently underway at New York-Presbyterian/Weill Cornell Medical Center and New York-Presbyterian/Columbia University Medical Center.
According to Jeffrey Milsom, MD, professor of surgery at Weill Medical College of Cornell University, the new procedure involves making a small incision over the anesthetized patient's pubic area and using a device called the GelPort to create an entrance to the patient's abdomen. The surgeon puts one hand through this device to find the affected part of the colon and uses the other to insert laparoscopic devices through one or two additional small incisions. The surgeon moves the infected section of the abdomen through the GelPort for removal, similar to what is done in open surgery. Then the colon is restored and the patient's incisions closed.
Such hand-assisted surgery lets physicians use their sense of touch to identify infected areas and to better control the bleeding, says Richard Whelan, MD, chief of colon and rectal surgery at New York-Presbyterian/Columbia University Medical Center. "Because the colon is resected outside the abdomen, a sometimes difficult and laborious laparoscopic resection is not necessary," he says. "Our study may show that these advantages help cut down on the time of the surgery."
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| Colectomy Procedure Combines Best of Two Approaches
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Surgeons may debate the merits of open surgery versus laparoscopy for a partial colectomy procedure, since both approaches have their advantages. But one answer may lie in combining the benefits of each, which may reduce the amount of time it takes to perform the procedure.
An experimental study comparing hand-assisted laparoscopic surgery, which will combine elements of open surgery with laparoscopy, against standard laparoscopic colectomy is currently underway at New York-Presbyterian/Weill Cornell Medical Center and New York-Presbyterian/Columbia University Medical Center.
According to Jeffrey Milsom, MD, professor of surgery at Weill Medical College of Cornell University, the new procedure involves making a small incision over the anesthetized patient's pubic area and using a device called the GelPort to create an entrance to the patient's abdomen. The surgeon puts one hand through this device to find the affected part of the colon and uses the other to insert laparoscopic devices through one or two additional small incisions. The surgeon moves the infected section of the abdomen through the GelPort for removal, similar to what is done in open surgery. Then the colon is restored and the patient's incisions closed.
Such hand-assisted surgery lets physicians use their sense of touch to identify infected areas and to better control the bleeding, says Richard Whelan, MD, chief of colon and rectal surgery at New York-Presbyterian/Columbia University Medical Center. "Because the colon is resected outside the abdomen, a sometimes difficult and laborious laparoscopic resection is not necessary," he says. "Our study may show that these advantages help cut down on the time of the surgery."
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| Surgical Miscues Prominent in Indiana Report
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Indiana's hospitals and ASCs need to improve their protocols for preventing the leaving of foreign objects in patients during surgery and for preventing surgeries performed on the wrong body part, suggests a state-mandated report on medical errors released last week. This preliminary report (pdf) is the first to emerge from a medical error reporting system developed by the Indiana State Department of Health following a 2005 executive order from Gov. Mitchell Daniels, Jr., that aimed to reduce the occurrence of medical errors. A final report will be issued in August.
Between Jan. 1, 2006 and Dec. 31, 2006, a total of 287 facilities reported 77 reportable events, the report notes. Of those events, 72 occurred at hospitals and five at ASCs. Nine surgeries occurred on the wrong body part; four were performed at hospitals and five at ASCs. "Considering that ambulatory surgery centers perform only 28 percent of the (state's) surgical procedures, the rate for ambulatory surgery centers for this event is significantly higher than for hospitals," the report concludes.
Notably, hospitals reported 21 events of foreign objects retained in a patient after surgery while ASCs reported no such events. This finding, says the report, warrants further research to determine if the discrepancy is due to the type of surgeries performed at each facility or their varying practice protocols.
The Indiana reporting system is based on the National Quality Forum's list of 27 serious reportable events. Minnesota is the only other state currently employing a medical error reporting system based on NQF guidelines, says Betsy Lee, RN, MSPH, director of the Indiana Patient Safety Center.
Ms. Lee is actively involved in coordinating community patient safety improvement efforts into regional and eventually statewide coalitions. "We hope to link local efforts into national safety programs," she says. "By focusing on similar issues, we can identify problem areas and develop a standardized approach that can assist in reducing patient harm."
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| Medication Errors Report Paints Surgery as Risky Business
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Perioperative patients face an increased risk of harmful medication errors throughout the surgery process due to a lack of comprehensive oversight of medications, according to a new national study. U.S. Pharmacopeia's seventh annual Medmarx Data Report studied medication errors throughout the perioperative setting, from pre-op to the OR to PACU and including outpatient surgeries.
The largest known national analysis of perioperative medication errors, the Medmarx report examined more than 11,000 medication errors in the perioperative setting and revealed that five percent of those errors resulted in patient harm, including four deaths. The report found that medication errors occurring during the course of surgery are three times more likely to harm a patient than errors committed during other types of hospital care. Children are at higher risk for harm in the perioperative setting, with nearly 12 percent of pediatric medication errors resulting in harm.
One culprit: What many people generally call "surgery" is actually a system of several different departments that patients must be transported through to receive perioperative care, say the authors, and each department is likely to have different teams of healthcare providers.
"Even if located along a single hallway, these departments can be remarkably disconnected from one another," says Diane Cousins, RPh, one of the report's authors. "The fragmented system creates a high risk for harmful medication errors."
Most of the errors examined by the report involved antibiotics and painkillers. Common types of errors included healthcare providers giving the wrong medication, giving the wrong amount of medicine, giving medication at the wrong time, omitting a medication or dose or administering it incorrectly.
To improve patient safety and reduce the risk of medication errors, USP recommends that hospitals and health systems dedicate pharmacists to the perioperative units to oversee the distribution of medications and that their surgical staffs better coordinate patient handoffs.
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