Porter David A, Laratta Joseph L, Shillingford Jamal N, Trofa David, Reddy Hemant, Uribe John W, Yagnik Gautam P
Orthopaedics, Baptist Health South Florida, Coral Gables, USA.
Orthopaedics, Norton Leatherman Spine Center, Louisville, USA.
Cureus. 2019 Feb 19;11(2):e4091. doi: 10.7759/cureus.4091.
Objective To define the critical elements of common procedures in arthroscopic surgery. Methods A survey was administered to surgeons associated with the American Orthopaedic Society for Sports Medicine (AOSSM) to determine the critical elements for four common arthroscopic procedures: anterior cruciate ligament (ACL) reconstruction, knee arthroscopy with meniscal debridement or repair, rotator cuff repair (RCR), and capsulorrhaphy for anterior glenohumeral instability (Bankart repair). Respondents were asked which steps necessitated their direct supervision. The level of experience and practice demographics were also recorded. Results For all applicable procedures, patient positioning and closure were not considered critical steps. Establishing arthroscopic portals was critical for all procedures, except knee arthroscopy. Diagnostic arthroscopy was only critical in ACL reconstruction. Private practice surgeons considered every step of these common procedures to be critical elements. Less experienced surgeons were more likely to regard certain aspects of a procedure critical. Surgeons with >15 years of experience considered diagnostic arthroscopy critical to all procedures, whereas those with <15 years of experience did not. Unlike surgeons with a resident as first assist, surgeons with a physician assistant (PA) or nurse practitioner (NP) found every step of each procedure to be critical except closure and positioning. Conclusion Across all procedures, only patient positioning and closure were consistently regarded as non-critical elements. There were significant differences in responses according to experience and practice setting. Future research is necessary to determine the implications of these findings and guide the definition of the "critical portions" of surgery.
目的 确定关节镜手术常见操作的关键要素。方法 对与美国运动医学骨科协会（AOSSM）相关的外科医生进行了一项调查，以确定四种常见关节镜手术的关键要素：前交叉韧带（ACL）重建、半月板清创或修复的膝关节镜检查、肩袖修复（RCR）以及用于前盂肱关节不稳的关节囊缝合术（Bankart修复）。询问受访者哪些步骤需要他们直接监督。还记录了经验水平和执业人口统计学数据。结果 对于所有适用的手术，患者体位摆放和缝合不被视为关键步骤。除膝关节镜检查外，建立关节镜入口对所有手术都至关重要。诊断性关节镜检查仅在ACL重建中至关重要。私人执业外科医生认为这些常见手术的每一步都是关键要素。经验较少的外科医生更有可能将手术的某些方面视为关键。有超过15年经验的外科医生认为诊断性关节镜检查对所有手术都至关重要，而经验不足15年的外科医生则不这样认为。与有住院医生作为第一助手的外科医生不同，有医师助理（PA）或执业护士（NP）的外科医生发现，除了缝合和体位摆放外，每个手术的每一步都很关键。结论 在所有手术中，只有患者体位摆放和缝合一直被视为非关键要素。根据经验和执业环境，回答存在显著差异。有必要进行进一步研究以确定这些发现的影响，并指导手术“关键部分”的定义。
