At the UMKC School of Medicine’s Surgical Innovations Laboratory, Gary Sutkin, M.D., professor of surgery and associate dean for women’s health, is taking a different approach to research.
As director of the lab, Sutkin, who also serves as the Victor and Caroline Shutte Endowed Chair in Women’s Health, has gathered an interdisciplinary team to look at ways to make surgical procedures safer for patients.
Inside the “Surgilab” — his third-floor “think tank” — one can find a pair of large bean bag chairs sitting in a corner on a colorful rug. A portion of one wall is filled with large-screen video monitors. A rectangular conference table in front of the wall is surrounded by different colored chairs. This is all by design, Sutkin explains.
“It’s all about creativity,” he said. “The chairs being different colors represent different ideas that people bring forth. It wasn’t just convenience. The people we work with come from different backgrounds.”
Biomedical engineers, mechanical engineers, and even a theater instructor, gather to discuss surgical procedures and how the operating room team of nurses and technicians can more effectively work together. They do this through studying practitioners’ movements and non-verbal communications.
“We’re one big community here, trying to make surgery safer for patients,” Sutkin said. “We’re trying to make it safer by cutting down on errors and improving communication. The operating room is such a fast-paced, high-risk environment. You have all these people from different backgrounds trying to work together, all with the same goal to have an effective, safe surgery. But they have to communicate well to do that.”
Physicians learn to do better by talking about the mistakes that take place during surgical procedures. One of Sutkin’s projects involves interviewing a number of surgeons to get their perspectives on surgical errors and how to prevent them. It’s a topic that he says surgeons think about often and are quite open to talking about with colleagues.
“I’ve told my mistake stories over and over,” Sutkin said. “It’s only by putting them out in the open and talking about them that we can learn from them and fix our ways.”
The work of the Surgilab is supported by a grant from the University of Missouri Review Board and funding from Sutkin’s endowed chair appointment.
With his research assistant, Fizza Mahmud, and a cohort of interdisciplinary colleagues, Sutkin and company are also exploring the process involved in Midurethral Sling Surgery. The procedure is a minimally invasive approach to treating a common urinary problem of incontinence in women. But it also involves surgical risks.
During a work session, Sutkin grabs a handful of playdoh and begins to form a shape to help describe to the non-medical members of his team the female anatomy and how the surgical instruments are used during the procedure.
“Human error is a part of any high-risk industry,” Sutkin said. “Whether it’s aviation, the railway industry, or surgery, it’s going to happen. You’re never going to get it down to zero, but you’re always trying to make it lower and lower.”
Kayla Briggs, a sixth-year student at UMKC School of Medicine, is part of an 11-person group that left on March 18 for the Dominican Republic on an eight-day medical mission trip.
The team consists of physicians, nurses, paramedics, an interpreter and Briggs.
“We can all contribute to make the world a better place both near and far.”
– Kayla Briggs
Working from the Good Samaritan Hospital in La Ramona, Dominican Republic, the group plans to spend the first two days in clinics meeting patients and assessing needs before spending the remainder of its time performing surgical procedures.
“We will have two operating rooms, one for general surgery and one for urology,” Briggs said.
The team will be performing elective procedures such as repairing hernias, removing gallbladders and excising masses all in hopes of preventing patients from encountering more serious complications in the future.
Briggs will serve as the first assistant in the operating room once the surgery procedures begin. She has already completed seven months of surgical rotations at UMKC. On March 17, which was Match Day, Briggs learned that she will begin a surgical residency at the University of California-Davis Medical Center in Sacramento, California, this summer.
“I’ve done medical mission trips before but never a surgery trip, so I’m really excited about this trip,” she said.
The mission is a collaborative effort with the Dominican Republic Medical Fellowship.
Other members of the mission team include:
Glenn Talboy, M.D., Chair and Program Director of the UMKC Department of Surgery
Edna Talboy, interpreter
Teisha Shiozaki, M.D., chief resident, UMKC general surgery
Patrick Murphy, M.D., section chief, Children’s Mercy Department of Urology
John Gatti, M.D., director of minimally invasive urology, Children’s Mercy Department of Urology
Louise Davis, CRNA and mission trip coordinator
Reidun Fuemmler, CRNA
Scott Davis, CRNA
Vahe Ender, paramedic
Matt Libby, paramedic
DAY ONE, SATURDAY, MARCH 18
Today was quite the day – we had to be at the KCI airport at 4:30 am. After a relatively short layover in Chicago, we headed to Punta Cana, Dominican Republic.
The Dominican Republic is a hot tourist destination and the airport shows it. The terminals are modeled after tropical huts with straw roofs.
Navigating customs was surprisingly easy. After picking up our five duffels and several rolling bags of surgical supplies, we headed to the exit where our bags were scanned once more. Our surgical instruments looked like weapons in the scanner and we were held for nearly 30 minutes trying to explain who we are and what we’re doing here. After lots of talking (shoutout to Edna Talboy for being an incredible translator), we were released.
We rented our cars (a van and sedan) and were on our way to La Romana – about a two hour drive. The highway system is what you see in the U.S. and was easy to navigate. Once in the city and at our mission, we unloaded our personal belongings.
The mission has separate bunks for women and men with a common room. All our sheets and linens are provided.
After a great dinner of roasted chicken, rice, and beans, we headed off to Jumbo. The only way I can describe it is a mix of Walmart, Target, H.E.B., and a department store … except much shinier. They have EVERYTHING – food, clothes, electronics, appliances, outdoor supplies, you name it. It was fun to browse the aisles and see what brands are similar and what’s different.
After picking up some snacks, we headed back to the mission to meet Matt and Vahe, the two paramedics joining our group from Boston. We then walked to the local restaurant and had ceviche, calamari, and bruschetta. Needless to say, we all slept like rocks after a long day of travel.
DAY TWO, SUNDAY, MARCH 19
Because it’s the weekend, we slept in a bit. Breakfast was served at 8 a.m. and was a hearty offering of pancakes, bacon, sausage, and fresh pineapple and papaya.
After breakfast, we headed off to Hospital el Buen Samaritano. It’s a private hospital that is funded by the Village Presbyterian Church. The operating rooms have the basics – anesthesia machines, overhead lights, and one even has a C-arm for taking X-rays during orthopedic cases.
We spent the morning organizing the plethora of supplies – laparoscopic equipment, suture, instruments, suction tubing, drapes, sterile water, sterile towels, liter boluses, etc. After dividing the two operating rooms (one for adults, one for children), we headed to Jumbo again to shop. Then it was time for lunch.
After a busy morning, garlicky noodles with chili and a short siesta was just what we needed. Our afternoon was spent seeing all the patients that had been identified in the bateys (rural areas where the sugar workers live) by the promotoras (health promoter) as needing surgery.
On the adult side, 21 patients were scheduled for pre-operative evaluation. Patients were asked about their past medical history, any prior surgeries, and if they’d ever had trouble with anesthesia. Twelve were scheduled on the adult side with three more that will be coming tomorrow for evaluation (transportation can be an issue for some).
I was reminded time and time again just how rusty my Spanish is. Without Alex and Edna, our amazing translators, it would be impossible to provide safe and smooth patient care. After refueling with a dinner of roasted pork, potatoes, broccoli, and carrots, we indulged in coconut pie and passion fruit cheesecake from a local bakery. We then fell into our nightly routine: a walk to Jumbo followed by relaxation at the restaurant. Tomorrow, we start operating at 8 a.m.!
DAY THREE, MONDAY, MARCH 20
Breakfast is served at 7 a.m. on the days we’re working. Oatmeal and fresh fruit energized us for the day ahead.
We arrived at the hospital just after 7:30 and patients showed up shortly thereafter. On the agenda for the adult room was a laparoscopic cholecystectomy (removing the gallbladder), lipoma excision, and fibrous adenoma excision. The pediatric room performed three hernia repairs, one case involving the removal of a child’s extra digits (called polydactyly), and a ganglion cyst excision.
It felt great to be back in the OR! After the first two cases, we took a break outside in the courtyard to eat a lunch of ham and cheese sandwiches and rice. There’s nothing like enjoying a real sugar sweetened Fanta underneath the warm Dominican sun.
We finished operating at around 4 p.m. After monitoring our last patients for post-operative complications, we instructed them all to return to clinic on Friday for wound checks.
Lyla Graham, a 12-year old from back home, had family and friends donate gifts for the children in lieu of receiving birthday presents for herself. We toted around a drawing of Lyla that we lovingly named ‘Flat Lyla’ (in the tradition of Flat Stanley) and snapped a few photos of the children with their gifts. These were not only a great tool for distracting purposes, but were also the sweetest parting gift before sending the children home.
Muchas gracias, Lyla!
We experienced our first tropical rainstorm (what seemed like a torrential downpour) of the trip during our evening siesta time. Dinner was fantastic – roasted chicken, rice, beans with lentils, roasted carrots, and fresh cherry lime juice. Dessert was just as good – a massive chocolate layer cake filled with dulce de leche.
Tomorrow is our busy day. Can’t wait to update you all on how it goes!
DAY FOUR, TUESDAY, MARCH 21
WOW – what a day!
Teisha said something the other day that resonated with me. When she’s not busy, she has a tendency to be lazy. When she is busy, she is more energized. I found myself relating to that and I think most surgeons would agree – downtime or a lighter schedule is nice, but being busy makes you feel productive and useful.
Today was our busy (and productive) day.
The pediatric room performed three cases (all inguinal hernias). We did six cases on the adult general surgery side: one laparoscopic cholecystectomy, two lipoma excisions, two inguinal hernia repairs, and one add on hydrocele repair. We did our best to stay on a tight schedule. I got to help a lot with our first lipoma excision (on the back of the patient’s neck) and got to perform a significant portion of the lipoma excision on our next patient’s arm (with the expert assistance of Dr. Talboy, of course!).
The first case – the laparoscopic cholecystectomy – was not without a few hiccups. The power in the Dominican Republic is not as reliable as in the States. Just as we were achieving our critical view the power went off – taking away our “eyes” by cutting power to our camera and light cord. In the room next to us, an OB/GYN was performing a c-section. After three minutes of wondering when the backup generator was going to kick in, the lights flickered back on. We heard a newborn’s cries shortly thereafter, and finished the remaining cases without further incident.
Our meals were fantastic. Breakfast was scrambled eggs and fresh croissants. Lunch was empanadas and rice delivered to the hospital. Dinner was roasted chicken, pasta, potato salad, fried plantains, tres leches cake, and banana pineapple juice. I don’t think any of us will come back from this trip any slimmer.
Today, we broke from tradition and drove to Plaza Lama instead of walking to Jumbo. Different selection, similar massive super store idea.
Our schedule is all downhill from here! We have two lipoma excisions and one inguinal hernia repair tomorrow. I’m excited for the lipomas – they’re satisfying.
DAY FIVE, WEDNESDAY, MARCH 22
Today was an eventful day. We started off with a breakfast of French toast and bacon before heading off to the hospital. Our first case went off without a hitch – an uncomplicated bilateral inguinal hernia repair. Our second case was a slightly more complicated. After a few tense moments, we successfully repaired a patient’s hydrocele and hernia. He was admitted to the hospital and we will check on him tomorrow morning.
We followed with a simple forehead lipoma excision. While in the recovery room, the patient and his mother took a look at our work in the mirror and returned to shake our hands numerous times. They were so thankful to have such a simple but visible problem resolved. It was a great reminder of why we do this.
During our cases, two c-sections were performed in the OR next to us. We had so much fun fawning over the babies; they were so cute.
After a quick lunch of braised chicken and rice, we finished up all the cases (including three inguinal hernia repairs on the pediatric side) by 1 p.m. We all looked at each other knowingly and said, “Beach day? Beach day.”
We returned to Casa Pastoral to grab our swimsuits and sunblock before heading to a public beach in Bayahibe, a 30-minute drive from La Romana. The scene was picturesque. A bright sunny day, sandy beach, beautiful water, happy voices of people from all over the world carrying in the wind, and plenty of Lay’s limón potato chips (our favorite!). The waves were so tranquil, perfect for jumping in without being too rough. I haven’t been on a beach since my fourth year in the program and I had forgotten how much I missed the ocean.
Dinner was (once again) delicious. Braised pork, rice and beans, and carrots with cabbage. Dessert was a super rich, super tasty carrot cake. After dinner, we walked to the central square in La Romana and went to Trigo de Oro, a French bakery and restaurant. At about 8:30 p.m., yawns were circling the table and we decided it was time for bed.
Tomorrow is a quick day – two lipoma excisions. Dinner will be at a pizza parlor on the river. Can’t believe tomorrow is our last day of operating!
DAY SIX, THURSDAY, MARCH 23
¡Hola mis amigos!
The name of the game is to front-load cases at the beginning of the week to make room for any add-ons. Today was a lighter day; we were scheduled for two cases in the adult room and three in the pediatric room.
First, we checked in on the patients we admitted to the hospital yesterday. They were doing well and were discharged later in the day. Our first case was a neck mass excision that we initially thought was a lipoma. After removal, we discovered that it was actually an infected cyst. The second was a foot mass that turned out to be a ganglion cyst.
Our pre-op and post-op room is the same three-bed space. Because the cases are elective procedures on healthy patients, once the patient is alert, can eat and drink, and is able to walk, he or she can go home. For cases like the foot mass, you want to ensure the patient isn’t in pain and won’t move during the case. Our awesome CRNAs came up with the idea to lightly sedate the patient and administer an ankle block in the hopes of numbing up their foot. Not only did this work like a charm (the patient snored as we were cutting out the large mass) but will also provide extended pain relief.
After both rooms had completed their first two cases, we hung around and ate empanadas with a side of rice and beans for lunch. The third child never arrived so we decided to pack up our equipment.
Louise, our mission coordinator, has been on this trip 21 times. Dr. Murphy has been on it many times, too. They’re experts at identifying what leftover supplies can be donated, what we should save for next year, and what we’ll need when we come back. That’s one thing I’ve loved about this trip. It’s a sustainable effort and you don’t leave feeling that without your presence, the patients are abandoned.
After packing up our supplies in the hospital, we headed back to the mission to clean up. We ate at El Chiringuito, a local pizza shop. The food was incredible – chewy pizza crust, plenty of cheese, and lots of fresh ingredients. The company was excellent, too.
Tomorrow, we will see patients back in clinic for post-op wound checks. Our afternoon will be spent at the beach with plenty of sunblock and Lay’s limón chips. Hard to believe this trip is almost over.
DAY SEVEN, FRIDAY, MARCH 24
After a breakfast of pancakes, bacon, and orange juice, we headed to Hospital el Buen Samaritano one last time. Seeing our patients in the post-op clinic was immensely gratifying. Patients and their family members were so grateful for their operations.
I continue to be amazed by this patient population’s tolerance of pain. Even those who had their operations two days ago were walking, talking, smiling, and taking minimal amounts of Tylenol and ibuprofen.
At around 10:30 a.m. we headed back to Casa Pastoral to get ready for the beach. The combination of a hot car, fatigue, and some questionable arugula on our pizza left my stomach feeling questionable. I made the tough decision to sit out of beach day and rest instead.
Folks headed off to the beach at around 11:30 a.m. It was rainy most of the afternoon and when they came back cold and soaking wet, I knew I made the right decision to stay. After an afternoon siesta, we enjoyed one last family dinner of pork steaks with rice and beans and a dessert of tres leches cake and Neapolitan ice cream. Our evening was a little shopping at Jumbo, a walk around town, and packing our bags.
Tomorrow, we will head to the airport at 8 a.m. I can’t believe this adventure is coming to an end.
DAY EIGHT, SATURDAY, MARCH 25
After a breakfast of sweet rolls with coffee, we headed to the airport. The drive through the Dominican countryside was gorgeous, lush green landscape and seemingly endless sugarcane fields.
Customs was busy. All flights out of Punta Cana leave between 11 a.m. and 2 p.m. and lines were especially long because it’s spring break for many.
After a stop at Chicago’s Midway Airport, we finally arrived in Kansas City at 8:30 p.m. We all said our “goodbyes” and “see you laters” before going our separate ways. For those who’ve been on a mission trip, you understand the craving for a hot shower and your own bed near the end of the week. While I don’t want to speak for everyone, I’m positive we all slept like babies.
This has been the adventure of a lifetime and I’m so thankful for the opportunity to share it with you! I hope to return to La Romana in the future as a surgery resident.
If you’re interested in going on a mission trip, I recommend finding one associated with an organization that has a permanent presence in the community you’re traveling to. This ensures that even after you are gone, the patients are still connected to care. And if foreign mission trips don’t fit into your budget, don’t forget about everyone in need in our own community and country. We can all contribute to make the world a better place both near and far.