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Should surgeons control fluoroscopy during urology procedures?

ABSTRACT: Our study explored the impact of switching from surgeon- to radiation technologist (RT)-controlled fluoroscopy on fluoroscopy and operative times. We also identified factors impacting fluoroscopy and operative times for ureteroscopy (URS) with laser lithotripsy.Patients undergoing urological procedures requiring fluoroscopy six months before and after the change from surgeon- to RT-controlled fluoroscopy were identified. Median fluoroscopy and operative times were compared between cohorts. Subgroup analyses were performed based on procedure performed. A multivariate analysis identified factors associated with increased fluoroscopy and operative times for URS with laser lithotripsy.Overall, no difference was found between surgeon and RT cohorts for fluoroscopy (58.0 vs. 56.7 seconds; p=0.34) or operative times (39 vs. 36 minutes; p=0.14). For URS with laser lithotripsy, fluoroscopy and operative times were longer in the surgeon-controlled cohort (76.0 vs. 54.0 seconds; p<0.01 and 48 vs. 40 minutes; p<0.01, respectively). For URS only, fluoroscopy time was decreased in the surgeon-controlled cohort (47.0 vs. 73.0 seconds; p=0.01). For URS with laser lithotripsy, factors independently associated with increased fluoroscopy time were male sex, flexible URS, glidewire use, and difficult ureteric stent insertion (p<0.05). Flexible ureteroscopy, glidewire use, previous ureteric stent placement, and difficult ureteric stent insertion were independently associated with increased operative time (p<0.05).Fluoroscopy and operative times are not significantly influenced by who controls fluoroscopy during urologic procedures. Patients undergoing URS with laser lithotripsy have decreased fluoroscopy and operative times with RT-controlled fluoroscopy. Patients undergoing URS only have decreased fluoroscopy times with surgeon-controlled fluoroscopy.

SUBMITTER: Setterfield J

PROVIDER: S-EPMC5167595 | biostudies-other | 2016 Nov-Dec

REPOSITORIES: biostudies-other

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Should surgeons control fluoroscopy during urology procedures?

Setterfield Jeremy J Watterson James J Playfair Mathew M Lavallée Luke T LT Roberts Matthew M Blew Brian B Oake J Stuart JS

Canadian Urological Association journal = Journal de l'Association des urologues du Canada 20161101 11-12

<h4>Introduction</h4>Our study explored the impact of switching from surgeon- to radiation technologist (RT)-controlled fluoroscopy on fluoroscopy and operative times. We also identified factors impacting fluoroscopy and operative times for ureteroscopy (URS) with laser lithotripsy.<h4>Methods</h4>Patients undergoing urological procedures requiring fluoroscopy six months before and after the change from surgeon- to RT-controlled fluoroscopy were identified. Median fluoroscopy and operative times ...[more]

PMID: 28028425

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Project description:Background:The use of fluoroscopically-guided interventional (FGI) procedures by orthopedic surgeons has been increasing. This study aimed to investigate the occupational radiation exposure among orthopedic surgeons in South Korea. Methods:A nationwide survey of orthopedic surgeons was conducted in South Korea in October 2017. The dosimetry data of the participants were obtained from the National Dosimetry Registry. The orthopedic surgeons were categorized by job specialty [spine or trauma specialists, other orthopedic specialists, and residents], and descriptive statistics for the demographics and work-related characteristics were presented. Multivariable logistic regression analysis was used to evaluate the risk factors for the orthopedic surgeons who were not linked with the dosimetry data. Results:Among the total participants (n?=?513), 40.5% of the orthopedic surgeons spent more than 50% of their time working with the FGI procedures when compared with their overall work. The average frequency of the FGI procedures among the orthopedic surgeons was 12.3?days per month. Less than 30% of the participants were regularly provided with radiation monitoring badges. The proportion of subjects who always wore lead aprons and thyroid shields were 52 and 29%, respectively. The residents group experienced more unfavorable working conditions of radiation exposure than the other specialists. The dosimetry data were not significantly linked among the residents (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.11-3.95) and orthopedic surgeons working at small hospitals (OR 4.76, 95% CI 1.05-21.51). Conclusions:Although orthopedic surgeons often performed FGI procedures, they wore protective gear less frequently, and a large proportion of orthopedic surgeons were not monitored by the national radiation dosimetry system. As the number of radiation procedures performed by the orthopedic surgeons increases, more intensive approaches are needed to reduce radiation exposure, especially for spine and trauma surgeons.

Project description:Background and purposeBenign prostatic hyperplasia (BPH) is the most common urologic disorder affecting older men, necessitating medical or surgical intervention. Limited data exists regarding the effect these surgeries have on the endourologist's musculoskeletal system following the surgery because of the required difficult posture, prolonged procedures, repetitive movements, and the settings of an adjustable visual display terminal workstation. The aim of our study was to survey the prevalence and possible causes of musculoskeletal disorders among endourologists performing transurethral resection of the prostate (TURP) or laser prostatectomy using either holmium laser enucleation or thulium laser enucleation.Materials and methodsAn email inviting all members of the Endourological Society to participate in the survey was sent. The questionnaire included different demographic and practice characteristics, with concern regarding performing either TURP or laser prostatectomy and the incidence and type of musculoskeletal incidents following these surgeries. All responses were collected by a commercially available internet based survey host (www.surveymonkey.com) over a period of 6 weeks.ResultsOf the 121 complete responses, 84 (69%) of endourologists complained of a musculoskeletal disorder following TURP or laser prostatectomy. The most frequent complaint was for neck (64%), followed by back (57%), shoulder (48%), hand (40%), and elbow (18%). The average prostate volume turned out to be the most compelling predictor for musculoskeletal disorder occurrence with an average prostate volume of 76 g operated on by the complaining group compared with 59 g in the noncomplaining group. Those with more severe symptoms were linked to a mean prostate size of 80 g (60-146) and constantly complained of shoulder, neck, or back trouble compared with the less-severely complaining group.ConclusionsA high prevalence of musculoskeletal complaints among urologists performing endourologic prostatectomy was confirmed and was found to be proportionally related to the size of the prostate. The integration of an ergonomic specialist inside the operation room to watch and correct the surgeon's position during endourologic procedures may reduce the endourologist's exposure to these occupational hazards.

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Should surgeons control fluoroscopy during urology procedures?

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Should surgeons control fluoroscopy during urology procedures?

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