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Surgical Disciplines (surgical + discipline)
Selected AbstractsAL03 ADVERSE EVENTS: OUR RESPONSIBILITY FOR REPORTING, REVIEWING AND RESPONDINGANZ JOURNAL OF SURGERY, Issue 2009J. Collins The sustained production of competent surgeons in sufficient numbers to meet the increasing needs of society commences with recruitment and selection of the most able medical graduates. As the process begins through self-selection, accurate information must be readily available to enable these graduates make an informed judgement on their career choice. Each surgical discipline aspires to use best practice selection in order to identify those who have the potential to acquire the necessary standard of technical and non technical skills and attributes required to practice as a surgeon. A selection system must rank applicants effectively and be reliable, valid, fair, defensible, cost effective and feasible. Best practice selection commences with an analysis of the relevant knowledge, skills, abilities and attitudes associated with successful performance in the particular target job. This information is used to construct a person specification in order to identify selection criteria at a level appropriate for entry to training. Selection methods are then chosen which will best elicit measurable applicant behaviour related to these selection criteria. A number of selection methods are used which include structured references, curriculum vitae and interviews. Other methods available although rarely used include tests of mental ability, aptitude tests and personality inventories. More recently selection or assessment centres (a selection method, not a place) involving a combination of selection techniques such as written exercises, interviews and work simulations have been shown to be highly effective. Eligibility criteria for application (long listing), shortlising for interview, scoring of items within each selection method and overall % weighting for each method are important variables in the selection process. [source] Robotic-assisted single-incision right colectomy: early experienceTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 4 2009Matthew B. Ostrowitz Abstract Background Application of laparoendoscopic single-site surgery (LESS) is increasing across surgical disciplines. In addition to the possibility of decreased postoperative pain, LESS offers better cosmesis with virtually ,scarless' surgeries, while avoiding the increased costs and complexity of natural orifice surgery. Instrument conflict minimization often requires the crossing of articulating instruments, which we believe can be more intuitively facilitated using the daVinci-S® robotic system. We describe our early experience with three robotic single-incision right hemicolectomies. Methods Three robotic single-incision right hemicolectomies were performed using the daVinci-S robotic system, utilizing a single 4 cm incision through or around the umbilicus. The procedure was performed using three robotic arms, a 12 mm camera and two 8 mm robotic ports. A medial to lateral approach was used and an extracorporeal resection and anastomosis was performed after undocking the robot. Results There were no intraoperative or postoperative complications. Average operative time was 152 min. The first case was converted to non-robotic single-incision right hemicolectomy during mobilization of the ascending colon, due to uncontrollable air leakage around the ports. The second and third cases were successfully completed without air loss by purse-stringing sutures around each individual port and the use of the SILSÔ port, respectively. Conclusions Robotic-assisted single-incision right hemicolectomy can be successfully and safely performed using the daVinci-S robotic system. Several techniques may be employed to prevent the loss of pneumoperitoneum. We believe right hemicolectomy lends itself to single-site surgery because specimen extraction requires a 4 cm incision and may confer patient benefit, with decreased postoperative pain and improved cosmesis. By crossing the robotic instruments and reassigning control of the arms, the robot represents a means to help perform these procedures safely by allowing them to be performed in a more intuitive fashion. Copyright © 2009 John Wiley & Sons, Ltd. [source] Clinical Implications of a Close Vicinity of Nervus Dorsalis Penis/Clitoridis and Os PubisTHE JOURNAL OF SEXUAL MEDICINE, Issue 7 2008ABSTRACT Introduction., Close relation of nervus dorsalis penis/clitoris and os pubis has a major impact in surgical disciplines. Aim., To summarize a current knowledge about this region, represented by the course of sulcus nervi dorsalis penis/clitoridis. Methods., Literature search of years 1970,2007. Main Outcome Measures., In male, it accommodates nervus dorsalis penis whereas in female nervus et arteria dorsalis clitoridis. Lateral border of sulcus nervi dorsalis penis corresponds to vertical ridge and lateral border of sulcus nervi dorsalis clitoridis to ventral arc,two parameters, which are parts of the Phenice's method for sexing of isolated os pubis. Results., Exact preparation of nervus dorsalis penis is crucial in correct performance of conversion of genitalia in patients with transsexualism, in reconstruction of posterior urethra, in hypospadia, during performance of penile blockade during circumcision and in revascularization surgery of erectile dysfunction. Possible role of the sulcus nervi dorsalis penis in the Alcock's syndrome is discussed. Similarly, it is advisable to take care of nervus dorsalis clitoridis during reduction clitoridoplasty in patients with adrenogenital syndrome and during the insertion of transobturator vaginal tape. Injury of nervus dorsalis penis/clitoridis leads to hypestesia or anestesia of glans penis/clitoridis. The injury to arteria dorsalis clitoridis leads to bleeding and/or hematoma. Conclusions., Clinical anatomy of sulci is important in several situations in urologic surgery. It is possible to use sulcus nervi dorsalis penis/clitoridis for sexing of isolated pubis for antropological or forensic purposes.,edý J, Na,ka O, ,pa,ková J, and Jarolím L. Clinical implications of a close vicinity of nervus dorsalis penis/clitoridis and os pubis. J Sex Med 2008;5:1572,1581. [source] Removal of a Fronto-Ethmoidal Osteoma Using the Sonopet Omni Ultrasonic Bone Curette: First ImpressionsTHE LARYNGOSCOPE, Issue 2 2008Fabio Pagella MD Endoscopic exeresis of sinonasal osteomas usually implicates the use of surgical drills with some disadvantages, as underlined by many authors. A new device that performs an ultrasound bone emulsification has been proposed in recent years for bone removal in various surgical disciplines. In this case report, we present the first clinical ENT experience with this device in removing a fronto-ethmoidal osteoma, and we briefly discuss our impressions. [source] Evidence-based prescription of antibiotics in urology: a 5-year review of microbiologyBJU INTERNATIONAL, Issue 6 2009Ranan DasGupta OBJECTIVE To analyse the results of positive urine cultures over a 5-year period in a large hospital and urology department (amongst both inpatients and outpatients), assess the prevalence of different organisms and the resistance profiles of a range of antibiotics, and thus provide information on which organisms are likely to cause urosepsis. METHODS The use of antibiotics should be based on knowledge of which pathogens are present and what resistance patterns are emerging, particularly relevant in surgical disciplines like urology, as antibiotics are now routinely administered peri-operatively, whereby evidence-based prescription is preferable to generic guidelines. We therefore examined almost 25 000 positive urine cultures in our hospital over a 5-year period, and focused on the infections encountered amongst urology patients during this time. RESULTS A significant proportion of inpatient urinary infection (40%) is caused by Gram-positive bacteria such as Streptococcus faecalis, underlining the need for including Gram-positive cover during urological prophylaxis. The commonest pathogen remains Escherichia coli among both inpatients and outpatients. The ineffectiveness of common antibiotics such as ciprofloxacin and trimethoprim was identified, as was the increase in gentamicin resistance. CONCLUSION We propose using an aminoglycoside with a penicillin for high-risk cases (e.g. endoscopic stone surgery) while low-risk cases (e.g. flexible cystoscopy with no risk factors) might be managed without such prophylaxis. Pathogenic patterns and resistance rates should be monitored regularly. [source] | ||||||||||