Surgeon’s schedule
Surgeons routinely perform procedures that can last many hours, sometimes up to 12 hours or longer for complex surgeries. They have to remain focused and alert during the entire procedure to ensure the best outcome for the patient. This raises the question – what happens if a surgeon needs to use the restroom during a long procedure?
Surgeons carefully plan their surgical schedule to try and avoid this situation. They will typically schedule procedures with breaks planned in between cases. For example, a surgeon may schedule 3 surgeries in one day with an hour break planned between each one. This allows time to complete the necessary tasks between cases (like speaking with family, reviewing next case, etc) as well as providing time to use the restroom.
Surgeons also try to properly hydrate prior to long cases and limit fluid intake during procedures. Staying hydrated is important but consuming too many fluids during a long procedure isn’t ideal if a restroom break isn’t possible. Some tips surgeons use include:
– Drink 16-20oz of fluid 2-3 hours before first scheduled surgery
– Limit fluid intake to 8oz per hour during cases
– Avoid caffeine or other diuretic drinks before/during surgery
Proper planning and preparation can help minimize the chances a surgeon will need an urgent restroom break during a procedure. However, sometimes the unpredictable can happen which leads to the need for backup planning.
Call for backup surgeon
If a surgeon determines that they need to immediately use the restroom during a procedure, the primary option is to call in a backup surgeon to temporarily take over until they can return. In hospitals, there are always emergency backup surgeons available for such rare situations. The backups are usually other surgeons with similar experience and skills, capable of stepping in and continuing the procedure seamlessly.
Here are the typical steps the primary surgeon would follow:
– Alert the nursing staff that they require a restroom break and need the backup surgeon paged immediately.
– Quickly summarize the case details and current procedure status to get the backup surgeon up to speed when they arrive.
– Thoroughly wash hands before and after restroom use.
– Return to the operating room as soon as reasonably possible.
– The backup surgeon summarizes what they’ve done and the current status of the case as they hand responsibility back to the primary surgeon.
– Primary surgeon resumes the procedure from there.
Having experienced backup surgeons available ensures the case can progress safely even if the primary surgeon requires a temporary break. The key is finding another surgeon familiar with the procedure who can smoothly substitute during the interim period.
Use surgical garments
Another option surgeons may utilize if they urgently need to urinate during a procedure are specialized surgical garments designed for such purposes. These provide a way to relieve themselves while staying sterile and not having to leave the surgical field.
For men, a type of external catheter called a urinary diversion device can be worn under surgical scrubs. This allows urine to drain into a collection bag strapped to the leg. For women, a similar product called a urine collection pouch can be worn.
Here are some key points on how these garments work:
– They are put on prior to surgical scrubbing & gowning to maintain sterility.
– Tubing allows urine to flow from the body into a leg collection bag.
– Valves prevent urine backflow and keep the surgical field sterile.
– Leg bags have antimicrobial properties and can hold up to 34oz of urine.
– Bags are opaque to remain discreet during use.
– The devices can stay on for prolonged periods if needed.
– They are disposed of after single use.
The benefits of surgical diversion garments are that they allow bladder relief without contamination. This provides an alternative to handing off the case to a backup surgeon. However, one downside is that wearing/using the device can be distracting and somewhat cumbersome during delicate surgery.
Ask surgical assistant to temporarily take over
In some situations where a backup surgeon is not immediately available, the surgical assistant may be asked to temporarily take over the main surgeon’s duties. This allows the primary surgeon to quickly use the restroom while the assistant monitors critical aspects and keeps the procedure progressing.
Qualified assistants like surgical residents or nurse practitioners trained in the specific procedure may be able to conduct simple interventions in the surgeon’s brief absence:
– Maintain hemostasis (control of bleeding) using cautery, irrigation, etc.
– Keep the surgical site visible by properly positioning instruments/retractors.
– Monitor vitals and clinical status of patient.
– Perform routine aspects like suturing blood vessels, incisions, etc.
– Handle any minor challenges until the surgeon returns.
However, surgical assistants would not make major decisions or conduct complex parts of the procedure in the surgeon’s absence. Their role is to keep things stable and safe until the surgeon can return within just a few minutes.
Surgical cases where breaks are not possible
While the above strategies help handle restroom needs during surgery, certain surgical cases do not allow any breaks whatsoever once begun. This includes very complex or risky emergency surgeries where the primary surgeon must stay absolutely focused on the task from start to finish.
Examples include:
– Major trauma surgery – Patient has suffered extensive life-threatening injuries that require complete focus to fix and stabilize bleeding, organ damage, etc. Surgeon cannot step away even briefly.
– Aneurysm repair surgery – correcting a bulging blood vessel requires meticulous work to avoid potentially fatal rupture. Surgeon must stay until vessel is sealed off and reinforced.
– Emergency C-section – if serious fetal distress occurs, urgent delivery may be needed and a restroom break could risk harm. Surgeon must continue until baby is delivered.
– Transplant surgery – delicate steps involved in connecting donor organs require steady hands and full concentration. Restroom breaks could compromise viability of donor tissue.
In these intense situations, surgeons have no option but to continue operating without a break. Their years of training helps them concentrate on the critical task at hand and tune out any distraction or bodily needs. Though extremely taxing both mentally and physically, preserving the patient’s life is the only priority.
Surgical complications from delays
While restroom breaks for surgeons during surgery are understood as a human necessity, any significant delay in completing the procedure does raise risks of complications. Here are some examples:
Infection risk
– Open surgical sites left exposed increase infection risk. The longer the site is open, the greater the chance bacteria can enter and colonize tissue.
Bleeding risk
– Blood vessels that are opened but not fully repaired can bleed until the surgeon returns to properly seal them. Significant blood loss can occur.
Conversion to open surgery
– For laparoscopic procedures, delays may lead to abandoning minimally invasive approach and converting to open surgery if issues arise.
Organ ischemia
– When doing organ transplant surgery, prolonged time without blood flow increases damage to donor tissue. Higher failure rates of transplanted organ.
Prolonged anesthesia
– Extended surgery time means extended anesthesia exposure. This has risks like blood pressure changes, breathing issues, medication reactions.
While most restroom breaks last just a few minutes, this is enough time for problems to escalate if prompt surgical intervention is needed. so backup support is critical.
Use of diapers
In very prolonged surgeries that exceed 6-8 hours, surgeons may end up wearing adult diapers as a last resort option to allow restroom needs if required. This avoids having to take any breaks that could jeopardize the surgery.
Here are some key points on use of diapers during surgery:
– Only considered for extremely long and complex procedures where any break is risky.
– Allows surgeons to urinate or have bowel movements without stopping.
– Helps maintain their sterility and focus on case without interruptions.
– Diapers have absorbent padding and can hold up to several urinations if needed.
– Surgeons will double glove to further ensure no contamination while using diapers.
– Soiled diapers are promptly discarded and replaced as needed.
While use of diapers allows surgeons to complete surgery uninterrupted, they are far from ideal. Surgeons still find the experience uncomfortable and embarrassing. It is only used as a last option when taking any break could seriously harm the patient.
Policies on surgeon bathroom breaks
Most hospitals do not have formal written policies on surgeon bathroom breaks but handle emergent needs on a case-by-case basis. However, some key guidelines include:
– For low-risk elective surgeries, reasonable breaks are permitted as needed.
– For urgent or complex cases, backup surgeon should substitute whenever possible.
– Surgeon should alert staff if they anticipate needing a restroom break preoperatively.
– In true surgical emergencies, breaks cannot be accommodated. Preparedness like diapers may be required.
– Assistance from surgical residents or other providers can help enable brief breaks if truly urgent.
While allowing bathroom access seems humane, administrators still expect surgeons to exercise prudent judgment and not take unnecessary breaks that could impact patient care or operating room resources.
Improving break policies during surgery
Here are some ways hospitals can update policies to better accommodate surgeon bathroom needs when required:
– Formally include backup surgeon coverage as standard for procedures over 4-6 hours.
– Provide surgical urinary diversion devices for all surgeons as an alternative option.
– Ensure adequate surgical assistants are available to provide interim support as needed.
– For very long cases, factor in mandatory periodic micro-breaks for personal needs.
– Monitor surgeon hydration and encourage fluid intake within appropriate limits.
– Improve break coverage for obstetricians doing deliveries, which can’t always be predicted.
– Develop protocols on handoff of duties to ensure continuity if breaks become necessary.
While often downplayed as a minor issue, inadequate bathroom access during marathon surgeries can severely impact surgeon performance. Providing formal solutions as standard policy improves both patient safety and surgeon wellbeing.
Conclusion
While needing to suddenly use the restroom during surgery is an inconvenient situation, surgeons have developed methods to deal with such circumstances. Calling for backup support, using specialized urinary devices, or having a surgical assistant temporarily take over can allow a restroom break while keeping the procedure progressing safely. For extremely long and complex cases, surgeons may have no choice but to wear diapers as a backup option. While hospitals expect surgeons to exercise good judgment on breaks, formalizing backup coverage and other accommodations as policy will help meet surgeons’ personal needs in critical moments while upholding patient care standards. With proper planning and resources, this human limitation does not need to impair surgical care.