MMCB General Surgery

Maine Medical Center Biddeford – General Surgery Rotation  

Attending Surgeons: 

Dr. Natalie Calcatera (site director) – Cell: 937-371-1829   Email: Natalie.calcatera@mainehealth.org  

Dr. Robert Doiron (second contact) 

Dr. David Grubb 

Dr. Blair Baldwin 

Contact Dr. Calcatera before the rotation by phone or email to discuss the schedule and answer any questions.  

 

Rotation Goals and Expectations

Goals 

  1. Know the steps and anatomy of the surgeries listed below and any other scheduled cases  

  1. Stepwise progression through the surgical cases 

  1. Manage elective patients from pre-op to discharge, and inpatient consults from admission to discharge  

  1. Evaluate general surgery patients in clinic, including performing a history and physical exam, formulate a plan for workup or surgery, proper documentation, and coding of the visit.   

 

Expectations 

  1. You should round in the mornings before cases. You should see the patients you have operated on and seen in consultation.  Check in with APPs for the day – one APP will be assigned to each patient as a backup.   

  1. Be on time for cases.  Read about the patient and review any relevant labs or imaging ahead of time.  If you have questions, you can reach out to the surgeon the day before.  Confirm that the H&P and consent are done on the day of surgery, and you should roll into the room with the patient.  Enter post-operative admission or discharge orders.  Expect to debrief the case with the surgeon.     

 

Schedule 

  1. Each week you will be assigned to one of the general surgeons.  You will follow their daily schedule – clinic, call, OR.  If your assigned surgeon is out, you will be given a new assignment for the day.   

  1. General surgery clinic is located at 9 Healthcare Drive, Ste. 204, Biddeford.  

  1. Bariatric clinic is located at 72 Main St., Kennebunk 

  1. Your time should be accounted for throughout the week and any absences should be preapproved or scheduled, except for Tuesday and Thursday morning conference.  You are not expected to round in Biddeford before your conference.   

 

Call and patient coverage: 

  1. Attending call schedules can be found on Amion, but will also be given to you at the beginning of the rotation.   

  1. When your assigned surgeon is on call Monday – Thursday, you will be first call for floor pages from 5p-7a from home.  This is typically low volume and could be 0, 1, or 2 nights (max).  The attending is immediately available by phone as backup, and you are not expected to drive in to triage a sick patient.  The attending is first call for the ED and new inpatient consults.  Your attending will notify you of any emergent operative cases to be performed overnight.  Your attendance to assist an emergency case is requested but not mandatory if you have other obligations (conference the next morning, etc).   

 

Operative goals: 

  1. Autonomy is dictated by experience and progression. The more present you are in the OR, the more you will get to do.  As you show competency and knowledge of the flow of the case, you will be able to do more. 

    1. It is helpful to have a specific objective for each case. 

    2. Have a learning plan and discuss this with the operating surgeon BEFORE the case, and ideally at the start of the rotation. 

  2. Sleeve

    1. Access/Port placement 

    2. Greater curve dissection 

    3. Intra operative endoscopy

    4. Stapling 

    5. Specimen removal and closure 

  3. Gastric Bypass 

    1. Port placement 

    2. Identification of ligament of Treitz and running small bowel 

    3. Laparoscopic suturing/pexy of small bowel

    4. Creation of JJ 

    5. Mesenteric closure

    6. Omental splitting

    7. Peri gastric dissection 

    8. Pouch creation 

    9. GJ anastomosis 

    10. Intra operative endoscopy 

    11. Closing 

  4. Hiatal hernia repair 

    1. Setting up the case: Entry/port placement/liver retractor 

    2. Intraop endoscopy 

    3. Hiatal dissection: if you can assist with the dissection with minimal direction, you will get more autonomy to do the dissection. 

    4. Hiatal closure: laparoscopic sewing and tying (Beware the aorta and IVC) 

    5. Sac dissection 

  5. Fundoplication 

    1. Setting up the case: Entry/port placement/liver retractor 

    2. Intraop endoscopy 

    3. Hiatal dissection 

    4. Greater curvature dissection 

    5. Hiatal closure 

    6. Wrap placement/creation 

  6. Laparoscopic inguinal hernias

    1. Camera management 

    2. Flap creation 

    3. Anatomic dissection 

    4. Mesh placement 

    5. Flap closure 

  7. Open ventral hernias 

    1. Entry 

    2. Lysis of adhesions 

    3. Retro-rectus dissection 

    4. Possible component separation 

    5. Closure and mesh placement 

  8. Robotic ventral/inguinal hernias 

    1. Lysis of adhesions 

    2. Flap creation 

    3. Dissection 

    4. Mesh placement 

    5. Flap closure 

  9. Thyroidectomy/parathyroidectomy 

    1. Anatomy 

    2. Exposure 

    3. Identification of the RLN and parathyroid glands  

    4. Safe dissection  

  10. Laparoscopic or robotic cholecystectomy 

    1. Safe entry into the abdomen 

    2. Port placement  

    3. Retraction of the gallbladder and exposure 

    4. Safe dissection and obtaining the critical view 

    5. Appropriate ligation 

    6. Extraction and closure 

    7. Cholangiogram 

Other common cases: partial colectomy, colostomy creation, appendectomy, pilonidal cyst excision, hemorrhoidectomy.