10 steps to a new in-practice procedure

Follow these steps to successfully implement new surgical procedures in your practice

Incorporating a new procedure into your practice is a big deal. It’s not as simple as merely learning how to do something new. Follow these 10 steps to successfully implement a new surgical procedure in your practice.

1. Decide

First, you need to determine what type of surgery you would enjoy providing to your clients and patients. Choose a surgical procedure strategically based on the needs and culture of your clinic.

2. Educate

Now that you have chosen your future path, you need to take the necessary courses to learn everything about the technique. Attend lectures and wet labs you need to feel knowledgeable about the procedure.

Also read peer-reviewed articles about it—technique, results, complications, long-term studies, etc. Talk to colleagues who have experience with the procedure.

3. Equipment

Once you feel ready to perform the procedure, you need the proper equipment. Meet with the appropriate reps and discuss what you realistically need to perform the procedure.

4. Practice

Practice your new procedure by whatever means necessary before you perform it on an actual patient.

Depending on the type of surgery, you may be able to practice on a plastic model or on cadavers. Make sure you use cadavers ethically. Respect the animal before, during, and after your practice run.

Again, please do the right thing—practice several times before you move on to a live patient.

5. Train

Depending on the equipment, your staff may need to learn a new set of skills to recognize, clean, wrap, and sterilize new instruments. Make sure you don’t skip that step.

If you need intraop assistance, teach your technician or a colleague what their role will be so that you form a cohesive and efficient surgical team.

This new knowledge goes beyond your medical staff. Don’t forget to educate receptionists as well, so they know what your fancy new procedure is about. They also will need to know how much time to block in your schedule when you are ready to perform it.

6. Pricing

It’s time to put a price tag on your new skill. This step is tricky. You want to factor in sunk-cost to learn the procedure, your time, new equipment etc. But be humble—you’re still a rookie who needs real-life practice.

7. Communicate

Be upfront with your clients. When you schedule the first patient for this new surgery, have a heart to heart with the pet owner and let them know that this will be the first time you are performing the surgery. Answer any questions they may have and reassure them that you are confident in your ability to perform the surgery by the book.

One little suggestion: Never perform a “first” on a pet who belongs to a relative, a staff member, or a lawyer!

8. Perform

You’ve learned it, practiced it, priced it, and scheduled it. Now it’s officially time to do it. Take a deep breath, round with your staff, double check your equipment, and get into the OR! You may have your anesthesia nurse take notes for you—questions that come up, things you now realize you should have asked, or an extra instrument that would have made your life easier.

Then, after you bask in the glory of your success, find answers to your questions before the next surgery. Continue to grow your skills, knowledge, and confidence. Perform as many procedures as possible to gain the experience and add them to your success file.

9. Marketing

Now that you have built your confidence and your staff is efficiently assisting you, it’s time to spread the word. Depending on your demographics, type of clinic, and kind of procedure, consider ways to market your new service. Spread the word to local colleagues you may be able to help.

Be logical. You probably shouldn’t place ads all over Facebook to promote the fact that you are now offering cystotomy and splenectomy at your practice!

10. Mastery

Your new surgical procedure is successfully established at your practice, so you’re done right? Wrong!

After surgery 101, if a surgery 102 course is available for that procedure, seize the opportunity to advance your knowledge and skills.

Here is a silly example: If you know how to perform an enterotomy, consider learning how to perform a resection and anastomosis.

Here is a real example in my surgical life: After performing tibial plateau leveling osteotomies for years, I took a course on “mini-TPLOs.” Since then, I’ve performed TPLOs on Westies, cairn terriers, bichons, etc. (This is a reminder that TPLOs are not performed based only on the patient’s weight, as many colleagues still believe, but based on the tibial plateau angle.)


No matter what you do, remain humble and don’t get into situations you might regret. Always place the benefit and well-being of your patient before your pocketbook and your ego. Refer patients to a specialist if it’s in their best interest.

And if you do perform an advanced procedure, do not fall into complacency simply because you are now comfortable with it. Keep honing your skills. There is no end to the surgical learning curve.

Dr. Phil Zeltzman is a board-certified veterinary surgeon and author. His traveling surgery practice takes him all over Eastern Pennsylvania and Western New Jersey. Visit his websites at DrPhilZeltzman.com and VeterinariansInParadise.com. Kat Christman, a certified veterinary technician in Effort, Pa., contributed to this article.

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