AUGUST 2019 • Volume 12, No. 8

From the Editor

Did you know Albert Einstein had surgery for an abdominal aortic aneurysm (AAA)?

In 1948, grafting procedures were still a decade in the future. Instead, the surgeon wrapped the visible anterior portion of the aneurysm with polyethene cellophane in an effort to strengthen the aortic wall. Einstein went on to live for five more productive years before the aneurysm ruptured, leading to his death.

A more detailed version of the above story, written by Albert B. Lowenfels, MD, is written as Famous Patients, Famous Operations, 2002 – Part 3: The Case of the Scientist with a Pulsating Mass, on Medscape. (You may be asked to log in to read the whole thing, but there is no charge and it’s a fascinating, quick read.)

One of the simulated labs we offer in our RNFA training is our Abdominal Aortic Aneurysm (AAA) Repair Lab, so we’ve chosen that procedure as the surgical topic for this issue.

Our Graduate in the Spotlight is Danielle Berthold, RN, ANP-C, RNFA, who has just been named NIFA’s APRN Graduate Advocate.

And scroll down for our monthly collection of RNFA jobs, plus NIFA’s favorite links.


Julie Lancaster, Editor
Photo of Albert Einstein by Oren Jack Turner [public domain]


Surgical Robot Snakebots

These robot snakes designed by AI could be the next big thing in the operating theater

“Researchers at the Australian Centre for Robotic Vision, part of the Queensland University of Technology (QUT), have been working on the concepts of surgical snakebots since 2015, with the aim of creating more flexible instruments for robotic surgery,” writes Jo Best, in a story that appeared this week on ZD Net.

“After sitting in on knee operations—arthroscopies, where surgeons perform keyhole surgeries to investigate and repair jointsthe QUT team saw there was a need for new tools that could go around corners and fit into the tight spaces of the knee, just a few millimeters wide.”

Now they have designed hardware made of pieces of metal that can telescope inside each other and curve around into small places. And through an “evolutionary” process, they are developing completely unique snakebots designed to match each patient’s anatomy and the specific surgery being done.

Read more on ZD Net
Read more from the Australian Centre for Robotic Vision

Photo: Australian Centre for Robotic Vision

Back to Basics:

Abdominal Aortic Aneurysm (AAA)

Approximately 13,000 deaths occur annually in the U.S. secondary to abdominal aortic aneurysm (AAA) rupture, according to an article in the New England Journal of Medicine. The frequency is higher in smokers and in males over 60 years old.

The following two sites provide a good basic overview on the condition and the two primary surgical approaches: traditional open repair and minimally invasive endovascular aneurysm repair (EVAR).

Read more:

Drawing: Stanford Health Care


Open Abdominal Aortic Aneurysm AAA Repair Abdominal Aortic Aneurysm (AAA) with Right Common Iliac Artery (CIA) Aneurysm and Left CIA Occlusive Disease. Houston Methodist’s DeBakey Heart & Vascular Center.  Watch video . . .

EVAR Animation.This 3D animation shows an endovascular procedure for an abdominal aortic aneurysm, in which catheters are used to place a stent graft in the aneurysm.Watch video . . . 

Environmental Cleaning Crossword Puzzle

This month’s all-new crossword puzzle addresses a topic of primary importance: Environmental Cleaning in the OR.

When you’re ready to check your answers, follow this link to see how well you did. Good luck!


Student Spotlight: Danielle Berthold

Danielle Berthold, RN, ANP-C, RNFA, has just been named NIFA’s APRN Graduate Advocate! Here’s her story.

I have been a nurse for 15 years, with the last 12 years spent as an Adult Nurse Practitioner. My bedside nursing was on a medical/surgical and kidney transplant unit.

After graduating as an NP, I spent 11 years working at a busy urban Level 1 trauma hospital with the Trauma and Acute Care Surgery team. I managed surgical patients on the floor, in ICU and in clinic. During that time, I greatly expanded my knowledge base and skill set, but the fact that I was never in the Operating Room always made me feel like I was missing out on the bigger picture of each patient’s care. I would take care of very sick patients in the ICU that would go back and forth to surgery multiple times, but if a resident didn’t give me a good sign-out or the operative report was vague, there would be times when I couldn’t answer specific patient or family questions and I disliked feeling under informed.

One day I was in clinic and palpated an incisional hernia at one of the trochar sites on a young child who had undergone a recent appendectomy. I ordered an ultrasound and touched base with the attending surgeon. “What?” she exclaimed. “No way, we don’t even close those trochar sites–they are just 5-millimeter ports.” The child did turn out to have a hernia (it took a MRI to find it) and needed to have it repaired. However, that experience really sparked me into action—I realized that unless I actually got into the OR, my practice would plateau and I’d never be able to know such subtleties.

The next week I researched First Assist programs and ultimately enrolled with NIFA. The training was wonderful. The six-day SutureStar™ workshop was incredibly well run, and I left feeling confident and prepared. Once I got into the OR, multiple surgeons commented that they wished they had been given such extensive preparation when they were in medical school.

One surgeon commented: “We got a four-hour suture lesson and that was it—we were on our own to figure the rest out ourselves.” Another surgeon invited me to start coming to the monthly medical student suture lesson to assist with teaching suture techniques and knot tying.

Getting into the operating room was scary—it was hard going from feeling like an expert in the ICU to fumbling with self-gowning, and praying I didn’t forget to take my rings off before I scrub, or forget to put on a bonnet cap before I cross the red line, or inadvertently contaminate a sterile field.

However, this has been one of the best things I’ve done for my career. We recently moved to a new state and now I work full time with a spine surgeon. I assist all of his cases, round on the inpatients every morning, and see the post-operative follow-ups. The continuity of care is incredibly fulfilling for both myself and our patients. And now, I can finally answer questions about all the little details of what happened in the operating room that didn’t make it to the final operative report. Thank you, NIFA!!!

If you have questions for Danielle, contact her at [email protected]


Jobs Front

Click here for the RNFA job postings we’ve collected for you this month.

NIFA – Office Hours

Monday-Thursday, 8:00am – 4:00pm
Friday, 8:00am – 3:00pm

Practice Resources

Here are several of the most-in-demand sites for our students, prospective students and grads:

MD Edge Surgery News: Specialty News and Commentaries, Videos and More
RNFA Scope of Practice by State (PDF)
ACS List of Cases that Require an Assistant at Surgery, 2018 (PDF)
Perioperative Nurse Links (state nursing boards & professional associations)
APRN Nurse Links

Disclaimer: The views expressed in this newsletter are strictly those of their respective authors and do not necessarily represent the views of NIFA. NIFA does not give any express or implied warranty as to the accuracy of statements made by our contributors and does not accept any liability for error or omission. It is the responsibility of all perioperative personnel to work within and adhere to their facility bylaws and individual scope of practice.

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