A surgeon's choice of equipment is occasionally limited by its availability
in a particular hospital's operating room. Many of the advanced operative
laparoscopic and hysteroscopic tools used by reproductive endocrinologists
are available in operating rooms in which infertility specialists routinely
Familiarity with the specific tools (equipment) to be used is of paramount
importance. The operating room personnel ("the team") as well
as the physician must know how to operate the equipment to facilitate
the preparation of the patient and "the room," enhance intraoperative
communication between members of the surgical team and guide postoperative
care. Troubleshooting is an ongoing and critically important aspect
of surgery. As a surgeon changes the approach taken during a case or
the tools required for the case in response to specific intraoperative
findings the OR team must be prepared to respond in a timely and accurate
fashion. Each member of the surgical team must understand their responsibilities
- the patient is adequately and accurately monitored prior to, during
and after the case
- the equipment is properly cleaned, in good working order and prepared
for use by the surgeon
- use of fluids (if any) is adequately and accurately (provided and)
monitored during the case
- the instrument and gauze pad counts are accurate at the conclusion
of the case
- settings for the equipment (on variables such as power) are accurately
provided as requested by the surgeon
- communication between the surgeon and the rest of the team is accurate
Miscommunication between members of the surgical team or failure to
understand one's responsibilities in the operating room can result in
mistakes. These mistakes can have a variable impact, ranging from an
annoying delay in the completion of the case to a poorer than expected
surgical outcome to even a surgical tragedy (longterm morbidity or death).
It is prudent for each surgeon bringing new technology into a hospital's
operating room to make sure that the team using the new equipment is
adequately prepared and familiar with the equipment prior to the actual
case so as to avoid mistakes. If the hospital's operating room is familiar
with the equipment to be used, then the surgeon usually lets the OR
know his preferences for types of solution, suture material, power settings
and the like.
Occasionally, a patient will request a particular tool be used for
the performance of her surgery. I have several patients who specifically
request that a CO2 laser be used for the treatment of their endometriosis
and may even recommend the wave form (ultrapulse or superpulse versus
continuous) that I use. Fortunately, I am very familiar with the most
modern lasers available for this type of laparoscopic surgery and these
lasers are available in the operating rooms in which I work. Therefore,
I am able to provide the highest quality of care that I am capable of
by applying cutting edge technology and using my extensive experience
with these sorts of cases.
On the internet, I am often asked questions like "which is the
best tool to treat endometriosis- laser, harmonic scalpel, or cautery."
I am the moderator for the "Endometriosis and Polycystic Ovarian
Syndrome" bulletin boards for INCIID ("www.inciid.org").
INCIID is the "InterNational Council on Infertility Information
Dissemination" (pronounced "inside") which is a nonprofit
organization dedicated to educating infertile couples about the latest
methods to diagnose, treat and prevent infertility and pregnancy loss.
INCIID is currently (1998) one of the internet's most active bulletin
board and chat group sites and couples from all over the world visit
it to ask questions about their situation.
In my hands I strongly prefer the ultrapulse type CO2 laser. However,
couples asking this question come from anywhere in the world and one
must recognize that in another surgeon's hands this type of laser may
be much less effective than another tool that the particular surgeon
is more familiar with. I always recommend allowing the surgeon who will
be performing the surgery to decide on the equipment to be used since
(s)he will know which tools are available in the chosen operating room.
The most important concern for the patient should be finding a (considerate)
surgeon with a good track record at achieving the goal desired (pain
relief, fertility, etc.) for the surgery contemplated.