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COMMENTARY
Year : 2014  |  Volume : 7  |  Issue : 3  |  Page : 288-289  

Surgeon performed ultrasound: Does this impact clinical practice?


1 Department of Surgical Gastroenterology, Lokmanya Tilak Medical College and Sion Hospital, Mumbai, Maharashtra, India
2 Lecturer in Gynecology and Obstetrics, Rajawadi Hospital, Mumbai, Maharashtra, India

Date of Web Publication18-Mar-2014

Correspondence Address:
Avinash N Supe
Dean, Lokmanya Tilak Medical College and Sion Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Supe AN, Supe PS. Surgeon performed ultrasound: Does this impact clinical practice? . Med J DY Patil Univ 2014;7:288-9

How to cite this URL:
Supe AN, Supe PS. Surgeon performed ultrasound: Does this impact clinical practice? . Med J DY Patil Univ [serial online] 2014 [cited 2021 Dec 3];7:288-9. Available from: https://www.mjdrdypu.org/text.asp?2014/7/3/288/128957

Ultrasonography is now a well-established tool for assisting surgeons in emergency situations especially acute abdomen. Though initiated by cardiologist and obstetricians extensively in clinical practice, its use by surgeons has evolved over last three decades. Though ultrasonography was used for the first time by a surgeon in 1946, surgeons became interested in performing ultrasound (US) in emergency only in last two decades. [1] As the role of the general surgeon continues to evolve, the surgeon's use of US will surely influence practice patterns, particularly for the evaluation of patients in the acute setting. With the use of real-time imaging, the surgeon receives "instantaneous" information to augment the physical examination, narrow the differential diagnosis, or initiate an intervention.

Focused assessment for the sonographic examination of the trauma (FAST) patient has been extremely useful in diagnosing patients with hemoperitoeum. [2] FAST is replacing central venous pressure measurements and diagnostic peritoneal lavage to detect hemopericardium and hemoperitoneum, respectively. With focused US examinations, the surgeon can rapidly evaluate adult and pediatric patients who present with an acute abdomen, especially those in shock. In the hands of the surgeon, this noninvasive bedside tool can more accurately assess the presence, depth, and extent of an abscess, confirm complete aspiration, or diagnose wound dehiscence before it is apparent on physical examination. In addition to abdominal trauma, FAST can detect a pleural effusion so well in critically ill patients that lateral decubitus x-rays are rarely needed.

Besides trauma, US is so accurate for the diagnosis of pyloric stenosis that it has essentially replaced the upper gastrointestinal series in most institutions.

Laparoscopic US allows tumor staging without formal celiotomy, and many hepatic and pancreatic surgical procedures include US as an adjunct. Endoscopic and endorectal US have added a new dimension to the assessment of many gastrointestinal lesions. Color flow duplex imaging and end luminal US have significantly expanded the diagnostic and therapeutic aspects of vascular imaging. US-directed biopsy of breast lesions is a common office procedure today. In recent years, sonography is a valuable addition to the general surgeon's diagnostic armamentarium and is rapidly becoming an integral part of the surgeon's clinical practice. Furthermore, an US-guided thoracentesis not only facilitates the procedure but improves its safety. Many ICUs now have protocols in place to perform routine duplex surveillance of those patients who are considered at high risk for the development of thromboembolic complications. As surgeons become more facile with US, it is anticipated that other uses will develop to further enhance its value for the assessment of patients in the acute setting. Understanding this importance, few medical schools in the USA have started training programs for surgical residents. [2]

Frezza et al [3] conducted study to evaluate accuracy as well as cost effectiveness of residents doing FAST in 650 trauma patients and found it to be 92% accurate and cost effective.

In the present study Srihari et al have undertaken to prepare a working model for surgical trainees and assess its effectiveness by training a single surgical resident. This was an innovative design where residents were initially evaluated followed by training for 2 months and then repeat evaluation. Results of US scan carried out by radiology residents was compared with scan done by surgery resident on same patient. Inter-rater agreement between both residents was assessed using Kappa coefficient. There was significant improvement in the second 10 months of the study. Authors have concluded that US scans can be performed by a surgery resident with similar results as that of a radiology resident.

Training of the surgery resident is possible with satisfactory results. Though there are similar studies available in western literature, this is the first study in India testing feasibility of resident surgeons performing US and its usefulness and authors need to be congratulated for designing and executing such a study in Indian settings. If authors could have extended this study to record perceptions of residents it would have enlightened us on how residents value this training.

Surgeons in training without pre-existing US experience and only a minimum of formal US education can perform valid and reliable US examinations in patients admitted with acute symptoms. US in surgeon's hand not only provides a quicker diagnosis but also enables better clinical correlation. However, we need to gather evidence to see whether this improves quality of care and patient outcomes.

 
  References Top

1.Ballard RB, Rozycki GS, Knudson MM, Pennington SD. The surgeon's use of ultrasound in the acute setting. Surg Clin North Am 1998;78:337-64.  Back to cited text no. 1
    
2.Rozycki GS. Surgeon-performed ultrasound: Its use in clinical practice. Ann Surg 1998;228:16-28.  Back to cited text no. 2
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3.Frezza EE, Ferone T, Martin M. Surgical residents and ultrasound technician accuracy and cost-effectiveness of ultrasound in trauma. Am Surg 1999;65:289-91.  Back to cited text no. 3
    




 

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