There was a scandal a few years ago when it was made known that salespeople for orthopedic prosthetics (hips, I think it was) were actually doing major parts of some operations -- fitting and inserting the joints because the surgeons weren't familiar with them. I never have, and never would allow such a thing (nor is it allowed anywhere, anymore), but there are times I've welcomed such detail folk into the OR. Most of them know their products very well, and when there's some sort of new wrinkle, it's nice to have them around. Here's the likely scenario:
Joe's Surgical Supply and Auto Shop comes up with a variation on a stapling device. Or an electrocautery unit, an adhesive dressing. They contact the hospital, or surgery center, and gain permission to show up with their device. Most often, they're hanging out in the surgery lounge when I arrive to do an operation. Sometimes, their impending presence has been announced: next week the rep from JSS/AS will be here to demonstrate a new foofratz. I look it over. In the case of staplers, which are extremely handy in certain situations, and which are quite regularly improved in terms of ease of use or extra features, I'm more than open to the latest innovation. If the demo looks promising, I'll let the rep know when next I'd be doing an operation for which it could be appropriate. They're there early the day of the operation, usually bringing doughnuts or pizza for the nursing staff. Who'd begrudge that?
I know how to staple bowel and when to do it. I know the various techniques, the tricks, the danger zones. But with a new instrument, I may not know how the re-designed handle works, or how to get it to bend in the newly-invented way. So the rep is there, in the OR (with the patient's permission!), and when the time comes he or she can give some instructions. From the sidelines: NOT scrubbed in. It's helpful, and I don't see it as any sort of breach of propriety. Sometimes I find the new item is no better -- and/or more expensive -- than what I've been using. Other times, it turns out to have major advantages, in which case I'll tell the OR it'd be nice to have them available (which may or may not happen!) It's even transpired that, after input from me and many others, a rep will get ideas of how their product could be improved and will take those ideas back to the shop. It is, I think, a mutually good thing.
Rants about over-use of staplers aside, I think I've made it clear I find them very handy in several situations; and I've always been impressed at the brilliance of the latest advances and the speed with which they occur. Reading about it isn't enough to decide; nor is it necessary -- given the fact that it's a trickle as opposed to a sea-change -- to take a course in the use. Having a knowledgeable rep around is just right.
One of the coolest improvements in a common technology of recent vintage is the development of "spray" mode for electrocautery. Electrically zapping something that's bleeding is generally quick and effective (assuming it's not the sort of bleeding you can hear, in which case you better have a big clamp handy.) But there's a problem: until recently it was usually necessary to touch the end of the cautery "pencil" to the tissue being cooked; and that tends to create a sort of black gob of charcoal glue, such that when the grilling is over, pulling away the pencil can pull away the char, and bleeding resumes. That's especially true for liver or spleen. You may have to try to control the bleeding with suturing, but those organs don't hold a stitch all that well. So when a rep hanging around the lounge approached me with his unit (should I rephrase that?), I was interested. It's perfect for liver and spleen, he said, because when you set it to "spray" and hold it close to the target, a broad electric arc jumps from the device to the bleeding area without the need to touch the two together. By golly, I had a gallbladder operation to do that very day, and it's not rare that a little bleeding needs attention where the gallbladder comes off the liver. It did, I did, and it did. Fantastic device, and I was glad to have the rep there to show the nurses how to set it up. Been using it ever since. And by the time I was finished that first time, all the doughnuts were gone.
