The second “time-out”: a surgical safety checklist for lengthy robotic surgeries

Robotic surgeries of long duration are associated with both increased risks to patients as well as distinct challenges for care providers. We propose a surgical checklist, to be completed during a second “time-out”, aimed at reducing peri-operative complications and addressing obstacles presented by lengthy robotic surgeries. A review of the literature was performed to identify the most common complications of robotic surgeries with extended operative times. A surgical checklist was developed with the goal of addressing these issues and maximizing patient safety. Extended operative times during robotic surgery increase patient risk for position-related complications and other adverse events. These cases also raise concerns for surgical, anesthesia, and nursing staff which are less common in shorter, non-robotic operations. Key elements of the checklist were designed to coordinate operative staff in verifying patient safety while addressing the unique concerns within each specialty. As robotic surgery is increasingly utilized, operations with long surgical times may become more common due to increased case complexity and surgeons overcoming the learning curve. A standardized surgical checklist, conducted three to four hours after the start of surgery, may enhance perioperative patient safety and quality of care.     

Health hazards due to pollution of waters along the coast of Visakhapatnam, east coast of India

Environmental pollution that renders waters along the coastline and beaches unsatisfactory for use by the general public has become a global health problem. This study was conducted to examine the effects of pollution of beach waters and sediment at seven selected locations receiving land drainage along a 45-km stretch of the east coast near Visakhapatnam, India. Pathogenic bacteria were identified using standard methods of culturing on selective media. The Pollution Index (PI) was determined as the ratio of fecal coliform/fecal streptococci. Protozoan cysts and helminth ova were also identified by microscopic examination of water after appropriate staining. The results suggested that the beach waters in Visakhapatnam are hygienically poor. A high PI of the water in Lawson's Bay indicated that the water was unsuitable even for noncontact recreation (boating, etc.). Pathogen densities dissipated considerably from the source to the low tide mark. Sediments had significantly higher bacterial and protozoan populations but pathogen concentrations were low except in heavily used areas. The general distribution pattern suggests that the nature of the sediment has a significant role in the retention of bacteria, protozoan cysts, and soil-transmitted helminths.