Surgery during the COVID-19 pandemic: Staying sharp

This article was reviewed by Manjool Shah, MD

In uncertain times, it is important to remain in contact with fellow surgeons in order to continue learning, growing, and developing.

“As I train my residents [and] fellows and work with my colleagues, we all recognize both the importance of maintaining surgical skills and how difficult this may be when the surgical volume dries up,” Manjool Shah, MD, emphasized, and provided some pearls that can help alleviate this situation.

Related: Pearls for practicing in the COVID-19 era​

Shah, a clinical assistant professor at the University of Michigan Kellogg Eye Center in Ann Arbor, equated being a surgeon and maintaining skills to being a member of a football team. The majority of players are off the field most of the time.

He pointed out that coaches use certain strategies for those players not on the field to keep them prepared and ready to perform when called upon.

Surgeons can prepare themselves for action by creating mental representations of themselves “in the game” through mindful and direct observation. They also can play the “anticipation game” by imagining what they would do next when faced with the current situation, he explained.

Additionally, Shah advised that surgeons have hands-on tasks that they can work on while sidelined; these tasks are directly related to the anticipated surgeries.

“These steps enable players to maintain a direct connection with what is happening in the operating room,” he said.

Related: Protecting cataract patients and their surgeons' practices​

Philosophies to live by
“Surgical skills start in your head and not in your hands,” Shah said. He pointed out that one way for surgeons to refine their skills is by watching videos of routine cases, such as a cataract procedure.

Shah suggested starting from the beginning without fast-forwarding the recording, even when nothing remarkable is happening.

“Feel that agony of stasis,” he said. “Watch actively, take notes, draw diagrams, imagine hand placement during the procedure and place incisions; pause, rewatch, rewind. Focus on fundamentals such as hand and phaco positions and second instrument position. Be critical of yourself and seek the ‘why’ behind every action or inaction that may occur and try to understand every nuance of the procedure.”

Importantly, Shah also suggested trying to devise at least 1 actionable change that can be implemented during the next surgery in the operating room.

Related: PPE packs helping ophthalmologists restore patient confidence amid COVID-19​ ​

After mastering a simple case, surgeons can advance to a more complicated surgery, such as a case of a dropped nucleus, in which things do not necessarily proceed as expected. The same steps outlined previously can be applied to these cases, too.

“Focus on the complications but instead [move] forward and backward in time in the video to determine how it happened, starting from the beginning, and how it was managed,” Shah said. “Find the cause before the root cause and imagine all the steps from the initial event to the complication and then beyond.”

Most importantly, the surgeon can determine productive tasks to work on to avoid this in the future in the operating room.

“Learn from others by standing on the shoulders of giants,” Shah said.

This can be tackled by reading the steady stream of surgical techniques that have been described in the literature.

“The act of reading a description before watching an accompanying video is useful. The Journal of Cataract & Refractive Surgery may be a good place to begin,” Shah noted.

Related: Perioperative medications can eliminate postoperative drops after cataract surgery​ ​

Following reading, now is the time to watch the videos. This can facilitate the learning of new techniques and how to manage challenging cases.

The American Society of Cataract and Refractive Surgery clinical education site and YouTube are all good sources.

“Be critical and [apply] those same watching skills. Pause the video at key intervals and ask ‘What would I do next?’” he suggested.

Shah also pointed out that surgeons can share the information they gained with colleagues and the community and discuss best practices, challenges, complications, and resources.

“We have opportunities to leverage teleconferencing options to build bonds and practice [distance] socializing,” he said.

Finally, Shah advised working on technical skills using a microscope or surgical supplies.

Related: Assessing the right angle: Surgeons getting back to basics​

“Devices and implants are often available from reps, and model eyes can be made specifically for many surgical techniques and can be reused,” he said.

The current environment will change, and ophthalmologists must be prepared for it.

“The crisis will end and we will be called off the bench,” Shah said, pointing out that the reduced surgical volume and delayed care can translate into some cases that may present increased complexity.

“Stay safe, stay sane, stay healthy, and stay sharp,” he concluded. “These directives apply with and without a pandemic.”

Read more by Lynda Charters

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Manjool Shah, MD
e:manjool@med.umich.edu
Shah has no financial interest in this subject matter.