USA procedures are an emerging group of minimally invasive solutions viewed in the context of the historical surgical experience. USAOP recognizes that small incisions, minimal dissection, office-friendly applications and increased income may be interpreted or marketed in an overly-simplified way.
Practitioners preparing for transition to this style of operating must have realistic expectations about launching a surgical practice, but through proper preparation the keyhole surgical practice is very safe and professionally rewarding. The challenge is to develop an understanding of basic sonographic anatomy and surgical concepts that meet the definition of a surgeon as “one who performs a surgery for a clinical problem, and is considered substantially equal amongst all others performing the surgery for the same problem.”
The process begins with didactic discovery and progresses to hands-on transition. USAOP has committed to this process of peer reviewed validation for its USA surgical concepts by employing the following general guidelines to actively assist practitioners in making the transition to USA surgery:
- Encourage practitioners to define and master a specific anatomic region by ultrasound for diagnosis and injections or “needling” until such efforts come easily. For example, one sign that a practitioner is ready to begin the transitional process to surgery is when diagnosis and injections (for example; CTS) can be done on demand during the flow of a normal clinic. [Ultrasound certification and accreditation, of course, increase professional credibility.]
- Read and discuss surgical literature to become familiar with protocols customary for a given problem. [ Challenges for non-surgeons will be in adopting a pre-operative patient work-up strategy, handling surgical instruments adroitly, understanding sterile technique, adopting OR style protocols (e.g the “time-out” procedure), positioning patients optimally (and not routinely), using antibiotics appropriately, managing bleeding/preventing hematoma, managing infection, and managing operative site pain.]
- Practice a given procedure in the cadaver setting while discussing the nuances of the procedure with a licensed surgeon who has performed the procedure successfully in live patients AND/OR establish training with a surgeon whereby the trainee learns a surgery over time preferably by assuming increasing responsibilities for the case. [The challenge for most surgeons will be to transition from outside-in (open/endoscopic) to inside-out (USA surgery by manipulating 2D cross sectional (gray-scale) pictures.]
- Begin live patient surgeries as the primary surgeon by choosing the least complicated cases (ie. a clear objective diagnosis, uncomplicated /virgin anatomy, sufficiently healthy tissues) preferably with a mentor present, and then progress experientially.
- Surgeons with US credentials wanting to “improvise” must assess risk: benefits for a patient, define the surgical objective and make the determination that USA surgery can accomplish the task with a specific gold-standard (usually open) procedure as a reference. [USAOP recognizes the importance of improvisation for an advanced surgical skill set. The term “improvise” signifies a measured expansion of surgical applications for a growing skill set. For this level of practitioner, USAOP, is attempting to create a supportive network for empiric consultation.]
In summary, practitioners that have acquired ultrasound diagnostic and injection/needling expertise can consider progressing to the USA surgeries. USAOP has designed a strategy of transition to ultrasound-keyhole procedures which begins Beta-testing in 2018. First, the physicians’/surgeons’ current skill-set and the breadth of desired surgeries are defined. A select group of procedures are then targeted followed by training, if necessary. Preparation continues until the practitioner has sufficiently learned the individualized goals whereupon live patient encounters are planned. USAOP then continues to collaborate with the physicians/surgeons by cataloging performance and collections-data to improve surgery selection and technique.
We value your thoughts on this subject and look forward to the safe introduction of keyhole technologies into the medical marketplace. For more information about USA (keyhole) surgeries please contact the USAOP staff to personalize your transitioning experience.