Roles and Responsibilities of the General Surgeon in Collaborative Endoscopic/Thoracoscopic (Spinal Access) Surgery
Preoperative Role and Responsibilities
The endoscopic general surgeon should arrange to interview and examine the patient preoperatively and should participate with the spine surgeon in development of an operative plan. Special attention should be directed towards suitability of the patient for anesthesia and for the proposed endoscopic procedure. The endoscopic surgeon should not feel obligated to participate in any procedure that he/she does not feel is in the best interest of the patient. Risks and complications unique to the endoscopic access portion of the procedure should be identified and communicated to the patient at this time, as well as the specific roles and responsibilities of the endoscopic general surgeon. The endoscopic general surgeon and spine surgeon should each communicate their individual experience in this procedure to the patient. This results in a true informed consent. Both co-surgeons must be named on the patient consent form.
Intraoperative Role and Responsibilities
Intraoperatively, the endoscopic general surgeon should participate in positioning the patient and selecting the proper locations of the trocars. The endoscopic general surgeon is not only responsible for safe entry into either the peritoneum or the retroperitoneum but also must participate in safe dissection to expose the proper spinal anatomy. He/she should be immediately available throughout the entire operative procedure. At the conclusion of the procedure, the endoscopic surgeon is responsible for safely exiting the peritoneum or retroperitoneum and for closure of trocar sites. The endoscopic surgeon must be capable of recognizing and managing intraoperative laparoscopic complications.
Postoperative Role and Responsibilities
The patient should be followed by the endoscopic surgeon postoperatively in accordance with the usual standards of practice for similar laparoscopic procedures. Discharge plans and instructions should be coordinated with those of the co-surgeon and provided to the patient. Outpatient follow-up should be provided to confirm absence of postoperative laparoscopic complications related to the access procedure. Any adverse outcomes must be communicated between the co-surgeons.
Documentation
Each co-surgeon must adequately document his/her respective preoperative, intraoperative, and postoperative participation according to Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards.
