question: How can there be surgeries lasting more than a few hours? Are they truly that intricate, or do things go wrong?
comment: They are truly that intricate. When my late mom had breast cancer she underwent a procedure that was extremely new at the time, but is commonplace now. It was called a tram flap reconstruction surgery. Basically the surgeon did a modified mastectomy, meaning he took the entire breast, but left some of the unaffected lymph nodes in her chest. At the same time a reconstructive surgeon made a cut along her bikini line, basically from hip to hip. He then sectioned a piece of her abdominal muscle without totally removing it, and then moved it and the attached fat under the skin, still attached and getting blood flow, to rebuild her breast. It was a new surgery for both surgeons at the time, although they had been extremely well trained in what to expect, and it went perfectly. The surgery that day took eleven and a half hours, although now that same surgery is regularly completed in eight hours or less. Surgery is incredibly complex, and everything must be done perfectly the first time around. It takes time.
passages: The estimate of how often this type of mistake happens is unclear. According to the U.S. Department of Health and Human Services, it is anywhere between 1 in 100 to 1 in 5000. However a study done in 2008 reported to the "Annals of Surgery" that mistakes in tool and sponge counts happened in 12.5% of surgeries. Additionally, the "Patient Safety Monitor Alert", announced in 2003 that 1,500 tools were stitched into patients each year. Khaled Sakhel, part of the Department of Obstetrics and Gynecology at the Eastern Virginia Medical School, reported that it is expected to occur at least once “in every 1,000–1,500” stomach surgeries. 
   Laparoscopic procedures are considered a form of minimally-invasive surgery. Several small incisions, called keyhole incisions, are made. These types of surgeries are associated with shorter hospital stays than open surgery, as well as less postoperative pain and scarring and lower risks of infection and need for blood transfusion.
   BULLET::::- By degree of invasiveness of surgical procedures: Minimally-invasive surgery involves smaller outer incision(s) to insert miniaturized instruments within a body cavity or structure, as in laparoscopic surgery or angioplasty. By contrast, an open surgical procedure such as a laparotomy requires a large incision to access the area of interest.
   An OR suite that puts up with excessive surgical times can schedule itself efficiently but still lose its financial shirt if many surgeons are slow, use too many instruments, or expensive implants, etc. These are all measured by the contribution margin per OR hr. The contribution margin per hour of OR time is the hospital revenue generated by a surgical case, less all the hospitalization variable labor and supply costs. Variable costs, such as implants, vary directly with the volume of cases performed.
   A surgical suite can schedule itself efficiently but fail to have a positive contribution margin if many surgeons are slow, use too many instruments or expensive implants, etc. These are all measured by the "contribution margin per OR hour". The contribution margin per hour of OR time is the hospital revenue generated by a surgical case, less all the hospitalization variable labor and supply costs. Variable costs, such as implants, vary directly with the volume of cases performed. 
   Vesselplasty is subject to similar problems as vertebroplasty and kyphoplasty. There are multiple techniques to master within the overall procedure, and the training period is not short. Surgeons needs to fully understand this process and to be well-familiar with any possible reactions of and to the cement mixture. Viscosity, injection time, and filling of the vessel need to be observed simultaneously under image intensification.
  
  Section::::See also.
  
  BULLET::::- Osteoporosis
  
  Section::::References.
  
  BULLET::::- Vertebral Augmentation With a Novel Vessel-X Bone Void Filling Container System and Bioactive Bone Cement
   While pain is universal and expected after surgery, there is growing evidence that pain may be inadequately treated in many patients in the acute period after surgery. It has been reported that incidence of inadequately controlled pain after surgery ranged from 25.1% to 78.4% across all surgical disciplines.
  
  Section::::Epidemiology.
  
  Section::::Epidemiology.:United States.
  
  In 2011, of the 38.6 million hospital stays in U.S. hospitals, 29% included at least one operating room procedure. These stays accounted for 48% of the total $387 billion in hospital costs.
   Section::::Evaluations.
   Success with ASD closure is very high, 96% for percutaneous procedures and 100% of ASD surgeries as found by one research group. No patient was found to have died from either interventional or surgical treatments and only 7.2% of patients
  
  who received a device and 24.0% of patients who had surgery had complications. The hospital stay for each group also varied, the surgical group was 3.4 ± 1.2 days and device group 1.0 ± 0.3 days. As seen by this study, prognosis was good and quality of life could be excellent.
  
  Section::::Treatments.:Device closure.:Surgically.:Side effects.
   Section::::Self-surgery.
   Between 2001 and 2016, the prevalence of musculoskeletal procedures drastically increased in the U.S, from 17.9% to 24.2% of all operating room procedures performed during hospital stays.
   Longer operation times than other procedures (3-3.5 hours), the need of technologically more advanced equipment and longer hospitalization cause higher costs than other commonly used, simpler procedures with limited effectiveness. Reported costs change between 15,000-25,000 USD.
  
  Section::::The operations.
  
  Ileal Transposition / Interposition should only be performed by surgeons with a dedicated team who received appropriate training and performed at least 100 operations under supervision. It should not be forgotten that even though this operation can provide miraculous results, it can lead to disastrous outcomes when performed by people who do not have the necessary qualifications.
  
  Section::::References.
   Major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. Due to robotic use, the surgery is done with precision, miniaturization, smaller incisions; decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification help to result in improved ergonomics. Due to these techniques, there is a reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.
  
  The existing open surgery technique has many flaws like limited access to the surgical area, long recovery time, long hours of operation, blood loss, surgical scars, and marks.
   The overall rate of complications during the 30 days following surgery ranges from 7% for laparoscopic procedures to 14.5% for operations through open incisions. One study on mortality revealed a 0% mortality rate out of 401 laparoscopic cases, and 0.6% out of 955 open procedures. Similar mortality rates—30-day mortality of 0.11%, and 90-day mortality of 0.3%—have been recorded in the U.S. Centers of Excellence program, the results being from 33,117 operations at 106 centers.
   At present there are many different bunion surgeries for different effects. The age, health, lifestyle and activity level of the patient may also play a role in the choice of procedure.
   Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed and so lessen wound healing time, associated pain and risk of infection. Surgery by definition is invasive and many operations requiring incisions of some size are referred to as "open surgery", in which incisions made can sometimes leave large wounds that are painful and take a long time to heal. Minimally invasive procedures have been enabled by the advance of various medical technologies. An endovascular aneurysm repair as an example of minimally invasive surgery is much less invasive in that it involves much smaller incisions than the corresponding open surgery procedure of open aortic surgery. This minimally invasive surgery became the most common method of repairing abdominal aortic aneurysms in 2003 in the United States.
   For spinal fusion surgery on AIS cases, with instrumentation attached using pedicle screws, complication rates were reported in 2011 as transient neurological injuries between 0% to 1.5%, a pedicle fracture rate of 0.24%, screw malposition assessed by radiography at 1.5%, 6% when assessed by CT scans though these patients were asymptomatic not requiring screw revision, and screw loosening noted in 0.76% of patients.
  
  Section::::Surgery.:After-surgery care.
  
  Section::::Surgery.:After-surgery care.:Pain medication.
   Many studies have shown that hospitals where a given operation is performed more frequently have better overall results (especially in the case of more complex procedures, such as pancreaticoduodenectomy). A frequently cited study published in "The New England Journal of Medicine" found operative mortality rates to be four times higher (16.3 v. 3.8%) at low-volume (averaging less than one pancreaticoduodenectomy per year) hospitals than at high-volume (16 or more per year) hospitals. Even at high-volume hospitals, morbidity has been found to vary by a factor of almost four depending on the number of times the surgeon has previously performed the procedure.
   There are four commonly used types of urethroplasty performed; anastomotic, buccal mucosal onlay graft, scrotal or penile island flap (graft), and Johansen's urethroplasty.
  
  With an average operating room time of between three and eight hours, urethroplasty is not considered a minor operation. Patients who undergo a shorter duration procedure may have the convenience of returning home that same day (between 20% and 30% in total of urethroplasty patients). Hospital stays of two or three days duration are the average. More complex procedures may require a hospitalization of seven to ten days.
  
  Section::::Phases of the operation.
   There is evidence that implants and procedures undertaken with computer-assisted orthopedic surgery have significantly higher levels of accuracy and precision However, it is not conclusive that CAOS technologies result in a significant long-term improvement in operative outcome, studies suggest that CAOS may lower revision rates. Further, because of the functional adaptability of bone, errors in component placement may become unimportant in the long term. Due to the relatively short time period over which CAOS has developed, long-term follow-up studies have not yet been possible. Whilst the surgeon (or even medical students in laboratory studies) can achieve better results in terms of planned vs. achieved placement of components, it is not clear whether the plan has been constructed optimally.
   Overall, the complication rate for this procedure is about 10% to 20%. The failure rate, or inability to repair the hernia, is approximately 5%.
  
  Section::::Outcomes.
  
  The outcomes of laparoscopic hernia repair versus open hernia repair support laparoscopic hernia repair as the method of choice. 
  
  Outcomes from having laparoscopic hernia repair are: 
  
  BULLET::::- A lower morbidity rate
  
  BULLET::::- Low mortality rate
  
  BULLET::::- Quarter inch to half an inch incisions that result in three small scars
  
  A laparoscopic hiatal hernia repair results in a hospital stay of approximately 36 to 48 hours after the procedure has been performed 
  
  Section::::Benefits.
   Choice of surgical method and anesthetic technique aims to reduce the risk of complications, shorten the time needed for recovery and minimise the surgical stress response.
  
  Section::::Description of surgical procedure.:Surgery.
   Use of mesh-based repair vs. suture-based repair has also been discussed. Some results suggest less inguinodynia after Shouldice (suture) than Lichtenstein (open mesh) for young men. Other studies find equal results between Shouldice and laparoscopic TEP. It must be recalled that the experience of the surgeon critically impacts the results, especially for Shouldice and laparoscopic repairs, which are fairly technical operations.
   Today, the laparoscopic technique has largely supplanted the traditional open repairs which involved either a tiny circular incision around the navel or the Ramstedt procedure. Compared to the older open techniques, the complication rate is equivalent, except for a markedly lower risk of wound infection. This is now considered the standard of care at the majority of children's hospitals across the US, although some surgeons still perform the open technique. Following repair, the small 3mm incisions are hard to see.
   An increased amount of chaos and distractions lead to a higher risk of a surgeon forgetting a tool. Mark Hulse from North Shore Medical Center said the following about surgery; “It’s a process that’s definitely subject to interruption and can be prone to errors. You’re doing a hundred other things at the same time, and as much as you try to keep your attention on it [sponge counts] if the surgeon needs something, it’s easy to get distracted.” Some aspects of surgery that can add to chaos are performing unforeseen changes in the procedure and undergoing emergency surgery. Consequently, the emergency room is the place most likely to make mistakes.
  
raw_presuppositions: Surgeries can't last that long and should be quick unless something goes wrong.
raw_corrections: Surgery is very complicated and really takes that long even without things going wrong.