Moving toward point-of-care surgery in Ukraine: testing an ultra-portable operating room in an active war zone

Emanuele Lagazzi; Debbie Lin Teodorescu; Dias Argandykov; Michael Alexander Samotowka; David Richard King

doi:10.1007/s00068-023-02410-w

Moving toward point-of-care surgery in Ukraine: testing an ultra-portable operating room in an active war zone

Eur J Trauma Emerg Surg. 2024 Jan 4. doi: 10.1007/s00068-023-02410-w. Online ahead of print.

Authors

Emanuele Lagazzi^{1

2}, Debbie Lin Teodorescu^{3

4}, Dias Argandykov¹, Michael Alexander Samotowka^#⁵, David Richard King^#⁶

Affiliations

¹ Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
² Department of Surgery, Humanitas Research Hospital, Rozzano, MI, Italy.
³ SurgiBox Inc., Cambridge, MA, USA.
⁴ Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁵ Division of Trauma, Department of Surgery, Novant Hospital, Charlotte, NC, USA.
⁶ Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA. dking3@mgh.harvard.edu.

^# Contributed equally.

PMID: 38175279
DOI: 10.1007/s00068-023-02410-w

Abstract

Purpose: In conflict zones, providers may have to decide between delaying time-sensitive surgeries or performing operative interventions in the field, potentially subjecting patients to significant infection risks. We conducted a single-arm crossover study to assess the feasibility of using an ultraportable operating room (U-OR) for surgical procedures on a porcine cadaver abdominal traumatic injury model in an active war zone.

Methods: We enrolled participants from an ASSET-type course designed to train Ukrainian surgeons before deployment to active conflict zones. They performed three standardized consecutive abdominal surgical procedures (liver, kidney, and small bowel injury repair) with and without the U-OR. Primary outcomes included surgical procedure completion rate, procedure time, and airborne particle count at the start of surgery. Secondary survey-based outcomes assessed surgery task load index (SURG-TLX) and perceived operative factors.

Results: Fourteen surgeons performed 76 surgical procedures (38 with the U-OR, 38 without the U-OR). The completion rate for each surgical procedure was 100% in both groups. While the procedure time for the liver injury repair did not differ significantly between the two groups, the use of the U-OR was associated with a longer time for kidney (155 vs. 56 s, p = 0.002), and small bowel (220 vs. 103 s, p = 0.004) injury repair. The average airborne particle count within the U-OR was substantially lower compared to outside the U-OR (6,753,852 vs. 232,282 n/m³, p < 0.001). There was no statistically significant difference in SURG-TLX for procedures performed with and without the U-OR.

Conclusion: The use of the U-OR did not affect the procedure completion rate or SURG-TLX. However, there was a marked difference in airborne particle counts between inside and outside the U-OR during surgery. These preliminary findings indicate the potential feasibility of using a U-OR to perform abdominal damage-control surgical procedures in austere settings.

Keywords: Austere environment; Disaster medicine; Emergency general surgery; Trauma; Ukraine.

Grants and funding

E22-05-PA-015/Medical Technology Enterprise Consortium