1145 Bridging the Gap: A Novel Approach to Communicate in the Surgical Suite in the Era of Minimally Invasive Surgery

Abstract

Video Objective Communication in the era of minimally invasive laparoscopic surgery poses challenges for the assisting surgeon and novice training surgical residents. Challenges are inherent to the unified surgical view in laparoscopy and the paradoxical directional commands rendered by the trocars' hinge point mechanism. Here we demonstrate a novel communication tool that helps make communication during laparoscopic hysterectomy uniform, clear and efficient. Setting Surgical assistance during a laparoscopic hysterectomy can be challenging especially in a setting of academia with the high turn over of training surgical residents. Laparoscopic hysterectomy is also unique in requiring intra-corporeal assistance in addition to extra corporeal uterine manipulation that is usually provided by an assistant who receives reversed directional commands. Interventions The new communication code is pre-introduced to the surgical assistants via a 15 min Power Point Presentation that contains review of laparoscopic pelvic critical surgical anatomy and presents the concept of the 8 cardinal pelvic views during the laparoscopic hysterectomy. Each view is given a code (e.g. A1, A2, A3) with predefined uterine manipulation angle and a predefined camera area of focus. Utilizing the 8 codes the uterine and camera assistants would not get directional commands that might be confusing, but rather would respond to the code request by adjusting visual views to match the predefined necessary exposure similar to the presented diagrams. Conclusion Utilization of the K code tool in laparoscopic hysterectomy reinforced preoperative surgical self coaching and briefing with the assisting staff. It also helped generate a shared mental model through which all assisting staff and surgeon could more easily communicate. A brief pilot period of utilizing the tool in two different institutions was very well received by all the surgical assistants with responses favoring utilization of this tool over the conventional directional commands method utilized traditionally in the operating room.