Train for the Worst to Make the Best of Risky Situations During Surgery

Shanda H. Blackmon, MD, MPH

Shanda H. Blackmon, MD, MPH

In the complex discipline of general thoracic surgery, the opportunity for catastrophic events has always been part of the job. But some believe “nightmare situations” are becoming even more common throughout the world.

“It doesn’t matter what country you’re operating in. During routine surgery, something unexpected will happen approximately 5% of the time,” said Shanda H. Blackmon, MD, MPH, from Mayo Clinic in Rochester, Minnesota. “During advanced surgery, complications are even more frequent.” 

Several risk factors contribute to problems, according to Enrico Ruffini, MD, from the University of Torino in Italy. The proliferation of new techniques is one concern, as are the broad surgical indications for elderly patients who suffer from major comorbidities. 

“These situations require experience, wisdom, technical skills, and, of course, a little bit of good luck,” he said. 

At Monday’s joint session organized by STS and the European Society of Thoracic Surgeons, which Drs. Blackmon and Ruffini will co-moderate, world-renowned experts from the United States, Europe, and Asia will discuss when and how to perform complex salvage techniques, including: 

  • Extracorporeal membrane oxygenation and other novel oxygenation strategies
  • An alternative conduit for complex esophageal reconstruction
  • A novel tissue scaffold for repairing tracheoesophageal fistulas
  • Integrated treatment for post-pneumonectomy complications
  • Anatomic dissection after immunotherapy

Except for advanced oxygenation strategies, the procedures that will be described can be performed by any thoracic surgeon at a typical community hospital. Attendees will discover how to optimize nutrition, manage pain, minimize aspiration, prevent inadvertent injury of adjacent structures, and control blood loss. 

Dr. Blackmon, known for videotaping all of her cases, believes simulation and practice are essential for success. She uses her in-depth videos to give transparent talks about managing interoperative events.

“Knowing how to get out of trouble in the operating room is very important,” she said. “Knowing how to prevent trouble is even more important.”

The practical, comprehensive information that will be presented at the STS/ESTS session should make attendees feel less intimidated about performing complex and aggressive surgeries at their home facilities.

“In the current climate of increased transparency, where everyone knows your outcomes, it’s tempting for some surgeons to avoid risky situations,” said Dr. Blackmon. “But I would challenge surgeons to recognize the potential for success. Salvage surgeries can go well if you train for the worst-case scenario and then work to prevent that from ever happening.”