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Sharpless Surgery: A Prospective Study of the Feasibility of Performing Operations using Non-sharp Techniques in an Urban, University-based Surgical Practice

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Abstract

Context

Percutaneous injuries occur frequently during surgical procedures and represent a significant occupational hazard to operating room personnel.

Objectives

To evaluate the feasibility of performing select general surgical procedures using a combination of non-sharp devices and techniques to replace the conventional use of scalpels and needles.

Design, Setting, and Participants

Candidate procedures for which sharpless techniques could replace conventional scalpels and suture needles were identified preoperatively in an urban, university-based general surgical practice over a 1-year period (June 2003–June 2004). Non-sharp techniques included monomeric 2-octyl cyanoacrylate adhesive, electrocautery, tissue stapler, and minimally invasive instrumentation. Conventional scalpels and suture needles were readily available and used whenever necessary.

Main Outcome Measures

We rated the feasibility of performing specific procedures without sharps. We also documented the rate of overall reversion to sharps during operations on patients that had been identified preoperatively as candidates for sharpless surgery.

Results

Of 358 procedures performed in the general surgery university practice, 91 were identified preoperatively as appropriate for sharpless surgery. Of these, 86.8% (79/91) were completed without the use of sharps, including 13/22 (59.1%) open laparotomy procedures, 20/22 (90.9%) laparoscopic procedures, and 46/47 (97.8%) soft tissue procedures. Intraoperative reversion to sharps occurred in 12 cases when deemed necessary by the surgeon.

Conclusions

Select common procedures can be performed entirely with sharpless techniques, eliminating the risk to surgical personnel associated with intraoperative percutaneous injuries.

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Authors and Affiliations

  1. Department of Surgery, John Hopkins University School of Medicine, Johns Hopkins Medical Institutions, 21224, Baltimore, Maryland, USA

    Martin A. Makary MD, MPH, Peter J. Pronovost MD, PhD, Eric S. Weiss MD, David Chang PhD, MPH, MBA, Edward E. Cornwell III MD, Dora Syin BA & Julie A. Freischlag MD

  2. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, 4940 Eastern Ave, Building A-5, 21224, Baltimore, Maryland, USA

    Martin A. Makary MD, MPH, Peter J. Pronovost MD, PhD, E. Anne Millman MS, David Chang PhD, MPH, MBA, Susan P. Baker MPH & Edward E. Cornwell III MD

  3. The Johns Hopkins Quality and Safety Research Group, Johns Hopkins Medical Institutions, 21224, Baltimore, Maryland, USA

    Martin A. Makary MD, MPH, Peter J. Pronovost MD, PhD & E. Anne Millman MS

Authors
  1. Martin A. Makary MD, MPH
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  2. Peter J. Pronovost MD, PhD
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  3. Eric S. Weiss MD
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  4. E. Anne Millman MS
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  5. David Chang PhD, MPH, MBA
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  6. Susan P. Baker MPH
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  7. Edward E. Cornwell III MD
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  8. Dora Syin BA
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  9. Julie A. Freischlag MD
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Corresponding author

Correspondence to Martin A. Makary MD, MPH.

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Makary, M.A., Pronovost, P.J., Weiss, E.S. et al. Sharpless Surgery: A Prospective Study of the Feasibility of Performing Operations using Non-sharp Techniques in an Urban, University-based Surgical Practice. World J. Surg. 30, 1224–1229 (2006). https://doi.org/10.1007/s00268-005-0605-9

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  • DOI: https://doi.org/10.1007/s00268-005-0605-9

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