Orange Surgery (Laparoscopic Surgery)

Rotation Director                   Bruce Schirmer, M.D.

                                                                                               

Attendings                               Stephanie Strauss, M.D.     

Course Curriculum

 The Orange Surgery Service focus has evolved recently to emphasize gastrointestinal diseases and procedures of the upper gastrointestinal system as well as the treatment of hernias. Resident staff for the service includes for this year a PGY-5, a PGY-3 or PGY-2, and one or two PGY-1 residents.  Support staff for the Orange Surgical Service include Anna Miller, R.N., patient care coordinator for Dr. Schirmer and for all bariatric patients, Jan Dix PA-C, responsible for outpatients for Dr. Schirmer.   The Surgical Nutrition Support team member, are involved in the nutritional support evaluation and consultation/care of bariatric patients and others with defined nutritional needs.

 

Learning Objectives

Upon completion of the orange surgery rotation students should be able to:

  • 1. Discuss the pathophysiology and associated medical problems of severe obesity
  • 2. Discuss the variations in physiologic responses in the severely obese, and their relevance to operative and postoperative care and as signs of complications.
  • 3. Discuss the indications and contraindications for a laparoscopic approach to surgery of the upper gastrointestinal tract.
  • 4. Discuss the pathophysiologic changes that occur during laparoscopic surgery, and the appropriate measures to ensure safe conduct of a laparoscopic operation.
  • 5. Discuss the evaluation and treatment of gastroesophageal reflux disease.
  • 6. Discuss the indications and appropriate approaches for repair of hernias of the abdominal wall and inguinal region.
  • 7. Discuss the indications and surgical approach for treating patients with calculous and calculus biliary tract disease, including methods of intraoperative imaging of the biliary tree.
  • 8. Discuss the treatment of common complications of postoperative patients undergoing gastrointestinal tract surgery.
  • 9. Develop a plan of care for all in-house surgical patients with whom they come in contact including patients with morbid obesity. This includes data collection, ordering and interpreting appropriate diagnostic tests, and working to provide a patient centered plan consistent with the resident's level of training
  • 10. Evaluate and develop a plan for patients seen in consultation in the emergency room or inpatient service
  • 11. Recognize significant changes in patient status.

 

Responsibilities

Medical Students should accompany the residents and participate in all aspects of patient care. The Orange Surgery team will be expected to perform the following:

  • 1. Provide all appropriate inpatient care for patients admitted to the Orange service.
  • 2. Provide all appropriate outpatient care for the above patients, as well as those outpatients seen in the clinics and in consultation with attendings from the Orange surgery service.
  • 3. Participate routinely in the operative treatment of those patients who have been seen by the team, and especially if possible by individual resident members of the team, during the preoperative period.  You should be completely prepared for every OR case prior to scrubbing in.  This means that you have reviewed the patient's history and know the results of all laboratory, radiology, and pathology studies.  In addition you will be expected to read about the patient's disease process, the treatment options, and the details of the proposed surgery, including relevant anatomy and the surgical techniques involved.
  • 4. Learn the appropriate postoperative care, both inpatient and outpatient, for patients with the problems outlined above.
  • 5. Participate in minimally invasive surgery for treatment of problems of the upper gastrointestinal system.
  • 6. Participate in open surgery for similar problems of the gastrointestinal system, particularly in situations where a laparoscopic approach is not indicated or possible.
  • 7. Review appropriate laboratory and study data results, reporting the status of each patient and their studies on rounds, and writing a daily progress note in the chart.
  • 8. Place a full written history and physical examination on the chart on the day of admission for all patients, insuring that appropriate brief chart operative notes are present for all patients, and dictating a discharge summary prior to each patient's discharge. They are also responsible for arranging the post-discharge care and orders and medications and follow-up, in coordination with the appropriate care coordinator for that patient.

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Weekly walk rounds and clinics will be used to assess student progress in mastering the fundamentals of patient care and management for pathophysiology seen on the service. Communication skills will be emphasized in the outpatient clinic, when obtaining information from patients, summarizing it in an appropriate presentation, and then performing an appropriate dictation or written report of the encounter.  Similar communication skills will be employed in the care and communication and documentation of inpatients.