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OBGYN.net Conference CoverageFrom the 31st Annual Meeting of the American Association of Gynecological Laparoscopists (AAGL)
Beverly Love, MD: Hi, I’m Doctor Beverly Love from Montgomery, Alabama, and today we’ve got with us Doctor Randall Loy from Orlando, Florida. I think that what you have developed here is something I’ve always thought about with laparoscopy and also hysteroscopy because one of the complaints I have in operating rooms is that I have a difficulty getting my instruments and the other people, the technicians, feel like I’m a perfectionist and I know that there are certain ways that we can organize things to where it works more efficiently, irrespective of who we work with in the operating room and I see that you have this new device, it’s called an Endo Organizer. What the heck is an Endo Organizer?
Randall Loy, MD: We have the same problem and we’re clinicians and how can we always get the right instrument when we need it? In surgery, as you know, seconds matter and if they’re having to fish around on the back table for the instrument, then you might have a bleeder there or you might need to do something and those seconds are critical, so we came up with a way that either the scrub or the surgeon can grab the right instrument at the right time. This device is just a toolbox, that’s really what it is. It’s like the old Craftsman toolbox, it sits there, except instead of screwdrivers and hammers, you’ve got your biopsy forceps, your coagulation device or whatever.
Beverly Love, MD: You mean to tell me you went into Sears and Roebucks one night and you had this brilliant idea that you had to organize things like a toolbox? I go into Sears at least every month or two and I haven’t had an idea like this. They wouldn’t, the lord wouldn’t let me get to think something like that. But I think you’re absolutely right and, you know, and I know it sounds, it may make things sound so Christian, but that’s exactly what you want to be, you want things to be more functional, you want the procedure to be made easier in terms of how you get your instrumentation and that’s one of the things that I’ve always had, but I think you’ve solved it with this device and I just want to let you see what Dr Loy’s prototype looked like for himself. Now I think this is a great, this is a great way of organizing things. Now is it only useful for gynecology or can other specialties use this device.
Randall Loy, MD: You know, we have in our tests, we’ve allowed surgeons of different sorts, including cardiovascular surgeons, general surgeons, urologists, OB/GYNs, of course, to use this and everybody is really like that. I mean, across the board, the surgeons have liked it. Now what the general surgeons especially like is they do different kinds of procedures, they may do a misanthundoplication one day, a lapcoly the next day, they might do a hernia the next day, and this is just the front plate of the box, of course, and they’re able then to have this customized front plate different for every procedure. So it could be Dr Smith misan, Dr Smith lapcoly, Dr Smith hernia, and they have different instruments in this thing and they’re ready to go. Some of these doctors even like the possibility of having their boxes up sterile with their instruments in them and they go to their next patient and bang, they’ve got their instruments ready to go and you brought up a point a minute ago that we have used this kit for both laparoscopy and hysteroscopy. We often operate concurrently and so I have one for the hysteroscopic instruments and then one for the laparoscopic instruments working at the same time.
Beverly Love, MD: You know that’s good because I think especially with hysteroscopy and gynecology, it used to be we didn’t have that much instrumentation and when you start talking about one set of instruments for the hysteroscope and one set of instruments for the laparoscope, then I know it can be confusing for different technicians and OR surgeons to say what device they actually want and I know some of them get upset with me because I say you don’t know the locations but I think this will solve one of the headaches because people may have difficulty recognizing which one goes with the hysteroscope, which one goes with the laparoscope, if you happen to be doing concomitant procedures.
Randall Loy, MD: You brought up two great points. As we know, there’s a nationwide nursing shortage and there are fewer and fewer scrub tech personnel, fewer and fewer nurses who are expert in endoscopy. So it’s not uncommon to get someone who’s pulled from orthopedics and neurosurgery who doesn’t know the instruments at all. Number two is we often operate in rooms where the lighting is low and where you can’t really see these tips, because the handles are all alike, the tips are what are different and so if you ask even a knowledgeable scrub tech, can you give me grasping forceps, it’s difficult to find those and you might often end up with scissors in those situations so we have less training and we have low handle power lighting making for wrong instrument selections.
Beverly Love, MD: Now how would you position this in the set-up in the operating room?
Randall Loy, MD: The way we’ve done it is put it right on the mayo stand, slightly hanging over the mayo stand and that allows us then to have access to it ourselves, we want to, now we typically would place this sort of between the patient’s legs overhanging the pelvis. Unless we’re doing hysteroscopy, of course, then it goes to one side or the other.
Beverly Love, MD: Now, if you have it like that, do you yourself as a surgeon grab the device, the instrument, or do you allow the tech to get the device for you?
Randall Loy, MD: It can be either way, it depends upon the tech. As you know, there are some techs who are pretty territorial and others who don’t mind if you grab the next. Both ways. You want to show the box at all?
Beverly Love, MD: Let me show the box.
Randall Loy, MD: It’s around the back.
Beverly Love, MD: And you can point out some of the instruments that we have on the front.
Randall Loy, MD: I mean the box back here. Should I get up and grab it?
Beverly Love, MD: No, no, no. I think that if we show right here the little template with your name on it with the different instruments.
Randall Loy, MD: All right. This, as you see, is customized to my name, the Olympus logo. I have set this up according to my typical usage. Here we have biopsy forceps, the second forceps, straight forceps here, another pair of grasping forceps, these are atriomatic, and then we have another pair of Olympus-type forceps, and scissors, Metzenbaum scissors, and I usually put the coagulation device in there, like Klezinger forceps in that last one. You could also put the Sonosurge instruments in there if you wanted to. The beautiful part, I think, about this is that it’s all refillable, you can flash this thing, you get it back next case, you can do three or four laparoscopies in a row.
Beverly Love, MD: Now does this device only work with Olympus instrumentation?
Randall Loy, MD: No, it does not. We have made this so that it is counterbalanced and there is also partial covering of the shelves inside of the actual box and so no matter how long the instruments or the counterweight on the tip of the instrument, it fits into this nicely. So any instrument works.
Beverly Love, MD: Now when will this device become available to gynecologists like myself?
Randall Loy, MD: I’m hoping in the first quarter of 2003 this will be available generally.
Beverly Love, MD: You know, I guess it’s good that this Endo Organizer was your invention because if I produced it, I’d have to give it a name like the Love Box and that might have all kinds of funny connotations and people may not figure out what it was for. Now, would you have several of these toolboxes in the operating room if you were the surgeon on a case? I guess you could, you told me about hysteroscopic surgery so you could had several boxes.
Randall Loy, MD: You could. The way I optimally envision this is to have one of the mayo stand and then one or two more on the back table so that if you need the instrument, let’s say you’re not using these seven instruments, but you ask for something like another grasp or another scissor, then the nurse or scrub tech goes right back to another second or third box and pulls the instrument immediately. They won’t have to re-focus the lighting and so forth.
Beverly Love, MD: Now what kind of comments have you got from other surgeons, gynecologists that have been using the box in your tests, your field tests?
Randall Loy, MD: We have, by the way, we’ve sent this out to the top gynecologists in the country, and without mentioning too many names, you get in trouble, but . . .
Beverly Love, MD: Some of., not all.
Randall Loy, MD: But we’ve sent this out to eleven very well-known names and many of these are department chairmen or division heads and just got their comments, say what do you think, use it, see it, touch it, feel it and to a person, they have had resoundingly good comments. I mean, they want to have it, they want it for their own surgeries, how soon can we get it, sort of like your comments.
Beverly Love, MD: Well, I think this is good and I think it would also cut down on the time element, make your procedures much more efficient. It’ll also cut down on the frustration factor and I think one of the things that’s always bothered me about doing procedures in that laparoscopy is that there’s a certain level of frustration because that cuts down on your own productivity, it makes you take longer to do your procedure and if we can have devices such as yours, and I mean this is part of what I call the KISS principle: keep it simple, stupid. In other words, you’re keeping it simple so that anybody that wants to participate can use a device like this and you can have different technicians come in the room and they don’t have to feel like I’ve never worked with you before, therefore I can’t help you or I don’t have an interest in what you’re doing because I usually work with neurosurgery or orthopedics and so on, I don’t know any of OBGYN instruments. They don’t have to know the instruments. If they know how to read, and I’m assuming they know how to read.
But certainly, most people who work in an operating room know how to read and would know the name of this instrument. This really is an advancement that will make it easier for us as gynecologists to do the procedures and I certainly would applaud you coming up with this idea. I just hate that it wasn’t my idea and I hope you come up with some more ideas along those lines because as long as we can come up with devices like this, we can keep the operating rooms running much more smoothly and we can save time and we can work more efficiently and that cuts down on cost even though I know there’s a cost associated with this, but it’s not going to be anything that’s monumental, it’s going to be something that would be well worthwhile spending in operating rooms because I know nowadays, it’s hard to get new things in the OR and if we’ve already got something like that but, as far as I know, there are no toolboxes in the operating room for laparoscopy or for hysteroscopy or for endo, endoscopic procedures, so certainly this is an advancement and we think this device, this toolbox that you have, this Endo Organizer is going to move forward and we see it as something that’s going to be in everybody’s OR at some point in time real soon.
Randall Loy, MD: I hope so. Thank you.
Beverly Love, MD: Oh, I thank you.
Randall Loy, MD: Yeah, I appreciate it.
Beverly Love, MD: Okay, good.
Randall Loy, MD: You’re a good man.
Beverly Love, MD: All right.