Retracting

[goooooober]

I have often heard that med students are sometimes used for retracting in the OR and that it sucks. What is retracting exactly and why is it so difficult? At what stage and until what stage is a med student suppose to do this before given more interesting tasks in the OR?

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[Castro Viejo]

As a med student all I used to do in the OR was retract (using an instrument to push/pull tissue out of the way so that the surgeon can operate and have a good field) and cut sutures. Then I graduated to throwing in a few sutures every so often, and finally, in my fourth year on a general surgery subinternship, I did an excision of a back lipoma with scalpel, bovie, and all that stuff.

 

[goooooober]

Thanx for informing me Wu.

 

[njbmd]

Originally posted by goooooober
I have often heard that med students are sometimes used for retracting in the OR and that it sucks. What is retracting exactly and why is it so difficult? At what stage and until what stage is a med student suppose to do this before given more interesting tasks in the OR?

Hi there,
The main job of a third-year medical student in the OR is to retract or "water ski" so that the surgeon can get good visualization of the operative field. Your other job is not not block the surgeon's visual field especially when the surgeon is wearing loupes. Try not to contaminate things but if you do, admit it and correct the situation. All of us have contaminated something as we were learning to work around sterile fields.

Other typical medical student jobs are camera driving on the laparoscopic cases. I can't tell you the value of a good camera driver.

I always let my medical students close the skin if they want to. It is good practice and most do an excellent job. I also permit them to carefully feel around in the abdominal cavity so that they get an idea of what's going on before we close. On things like a colectomy, I allow them to tie off some vessels on the colon after it has been removed.

It can get pretty boring if you are just pulling for hours so I try to do some teaching as I go. If things are tense, sometimes this is just not possible but I always appreciate the help of the medical student.

njbmd

 

[Winged Scapula]

Originally posted by goooooober
I have often heard that med students are sometimes used for retracting in the OR and that it sucks. What is retracting exactly and why is it so difficult? At what stage and until what stage is a med student suppose to do this before given more interesting tasks in the OR?

IN general, you should be allowed to do more as you become a more senior student and in cases when appropriate. For example, it is appropriate to allow medical students, 3rd Or 4th year, to apply skin staples or do some suturing. IMHO, you are highly unlikely to be allowed as a student to be sewing anastomoses or harvesting graft.

The more interested you see, the more likely you are going to be allowed to do. However, this will vary WIDELY with the resident, the attending, the time of day, how far behind the cases are, who the patient is (ie, if its a VIP you might be relegated to retracting). Visualization makes all the difference in the world and while its boring and painful physically, it contributes a great deal to the operation.

Ask politely (at any appropriate time...not when they've got welling venous ooze from an unknown site and are madly packing the abdomen) if you could tie a few knots or sew some of the wound closed. Most times you will be allowed to.

 

[Blade28]

Any advice on practicing suturing before the rotation starts? Any kits, helpful websites or books?

 

[Foxxy Cleopatra]

Originally posted by Blade28
Any advice on practicing suturing before the rotation starts? Any kits, helpful websites or books?

Ethicon has a great kit that shows you how to tie all of the various knots (I'd try to know the 1-hand, 2-hand, and surgeon's knot as a student if you are interested in surgery.) I also had a old book from them that described some suturing techiniques (like horizontal mattress, firgure of eight) thouh I wouldn't worry too much about that at the beginning of a 3rd year rotation.

If your school doesn't have a surgery interest group, you could probably hang out in the ER and ask some senior students or residents to show you how when the opportunity arises.

good luck

 

[Blade28]

Originally posted by Foxxy Cleopatra
Ethicon has a great kit that shows you how to tie all of the various knots (I'd try to know the 1-hand, 2-hand, and surgeon's knot as a student if you are interested in surgery.)

Thanks for the pointers! I've been browsing Ethicon's Products page (http://ecatalog.ethicon.com/ec_ecatalog/ethicon/default.asp), but I can't seem to figure out which kit to buy. Any recommendations?

Thanks for all the help!

 

[samsoccer7]

http://www.jnjgateway.com/public/USENG/5256ETHICON_Encyclopedia_of_Knots.pdf

On page 48, it says the practice board is available for free. I'm gonna email ethicon and ask for it.