SPMLs & EtOH

2. Why do it “ that way?” We don’t do the surgery that others do this way or that way.

We are doing something else . It turns out, as luck would have it, that we CAN use this as a less invasive way to be very selective as to how much & where and note overall change as we proceed. In our original tracked series of 500 cases, close to half also had additional open surgery. Most of the open surgery could have been prevented had we known what we now know 30 years before we first started doing this. Patients treated as babies to 2 yo very seldom need the big open surgery. We do, sadly, a lot of really big repair surgery. Why? It is referred from places without a clue about prevention. Also fear figures in. Parents who dread intervention and resist EVERYTHING are a huge source of bad outcomes. Percs? We called them ‘percs’, not as a name but as a check box for the operating room who has to set up our surgical tables with an array of many tools all sterilized and ‘spore tested’. It is expensive to do that. With SPMLs, we don’t need all that equipment as we are only doing percutaneous things (tiny poke holes) – percs, now called SPMLs. Operating Room “Case Card” = Dr. Name______________ [ ] C-arm & radiology table [ ] #10 surgical blades & handles [ ] oscillating drill + 2 battery cartridges [ ] Midas Rex air drill with M10 side cutter, other________ [ ]

… many more things [x] only percs [ ] cast cutter

THAT is what ‘percs’ means – we don’t need all the big tools and will only use simple drapes and maybe a few small dressings (ordinarily kept in room anyway).