Article
Surgery without any help – a so-called one-man-show
Operieren ohne Hilfe – One-man-show
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Authors
Published: | May 4, 2005 |
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Outline
Text
Objective
The resources in medicine are limited even in industrialised countries. On the other hand, the demands on medicine, especially on the surgical fields increase. We showed a different way in daily practice and evaluate this way prospectively against all odds. Because our local conditions are limited, we chose a different way for neurosurgical procedures in the newborn.
Methods
Standardized neurosurgical procedures for hydrocephalus and for meningomyelocele in children younger than 6 months are done without the help of a nurse or an assistance. So the surgery itself remains a one-man-show from cut to suture. Only during the sterile preparation of the operating table is the assistance of a semi-skilled person, namely a student required. The outcome of the operation, especially with regard to infections and bad healing of the wound is evaluated.
Results
Since 2001 we have performed 121 neurosurgical procedures in the described manner as a one-man-show. 13 children were operated on the day of birth, 28 in their first week of life and 71 in their first month of life. There were 40 primary implantations of a shunt system and 17 operations because of a meningomyelocele or encephalocele. No direct surgery-correlated infection occurred. There was a total of 4 infections. Two of them occurred in the CSF acquired at the beginning of the operation as a candida ventriculitis. One appeared after a CSF leakage of the wound of a meningomyelocele, and one in a Rickham-Reservoir after daily puncture for 8 weeks. In three cases we had to reoperate because of wound healing problems.
Conclusions
It is possible to have excellent results in standardized neurosurgical procedures without any aid during the operation as one-man-show even in high-risk patients.