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Surgical Practice (surgical + practice)

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Medical Sciences	96%

Selected Abstracts

ROLE OF TEACHING AUTOPSY IN CONTEMPORARY SURGICAL PRACTICE

ANZ JOURNAL OF SURGERY, Issue 9 2007
Professor Jeffrey M. Hamdorf FRACS
No abstract is available for this article. [source]

Colorectal Surgery: A Companion to Specialist Surgical Practice (Fourth Edition)

ANZ JOURNAL OF SURGERY, Issue 9 2010
FRACS, Graham Hool MB BS
No abstract is available for this article. [source]

Principles of Surgical Practice.

ANZ JOURNAL OF SURGERY, Issue 4 2003
BMedSci, Craig Semple MB BS
No abstract is available for this article. [source]

Complications of Minor Skin Surgery Performed under Local Anesthesia

DERMATOLOGIC SURGERY, Issue 8 2008
AVSHALOM SHALOM MD
BACKGROUND Minor surgical procedures performed under local anesthesia are the most common surgical procedures routinely carried out in every plastic surgical practice. OBJECTIVE The objective was to evaluate the prevalence of immediate local and systemic complications of such procedures. METHODS AND MATERIALS Records of 2,600 procedures performed under local anesthesia on 2,431 patients between November 2001 and May 2004 were reviewed. Local anesthetic complications and all surgical-related complications were recorded. RESULTS Procedure-related complications were 51 presyncope (1.9%), 4 true syncope (0.16%), 2 minor burns (0.08%), and 1 facial laceration (0.04%). CONCLUSIONS True allergic reaction to lidocaine is extremely rare and none was noted in our study. Most patients who claimed that they had suffered from such a reaction were probably experiencing symptoms related to intravenous injection administration, a reaction to the added vasoconstrictor (adrenaline), or a vasovagal reaction, which is a common trait among young adults. [source]

Electrosurgery, Pacemakers and ICDs: A Survey of Precautions and Complications Experienced by Cutaneous Surgeons

DERMATOLOGIC SURGERY, Issue 4 2001
Hazem M. El-Gamal MD
Background. Minimal information is available in the literature regarding the precautions implemented or complications experienced by cutaneous surgeons when electrosurgery is used in patients with pacemakers or implantable cardioverter-defibrillators (ICDs). The literature pertinent to dermatologists is primarily based on experiences of other surgical specialties and a generally recommended thorough perioperative evaluation. Objective. To determine what precautions are currently taken by cutaneous surgeons in patients with pacemakers or ICDs, and what types of complications have occurred due to electrosurgery in a dermatologic setting. Methods. In the winter of 2000, a survey was mailed to 419 U.S.-based members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO). Results. A total of 166 (40%) surveys were returned. Routine precautions included utilizing short bursts of less than 5 seconds (71%), use of minimal power (61%), and avoiding use around the pacemaker or ICD (57%). The types of interference reported were skipped beats (eight patients), reprogramming of a pacemaker (six patients), firing of an ICD (four patients), asystole (three patients), bradycardia (two patients), depleted battery life of a pacemaker (one patient), and an unspecified tachyarrhythmia (one patient). Overall there was a low rate of complications (0.8 cases/100 years of surgical practice), with no reported significant morbidity or mortality. Bipolar forceps were utilized by 19% of respondents and were not associated with any incidences of interference. Conclusions. Significant interference to pacemakers or ICDs rarely results from office-based electrosurgery. No clear community practice standards regarding precautions was evident from this survey. The use of bipolar forceps or true electrocautery are the better options when electrosurgey is required. These two modalities may necessitate fewer perioperative precautions than generally recommended, without compromising patient safety. [source]

Fundus rotation gastroplasty: rationale, technique and results,

DISEASES OF THE ESOPHAGUS, Issue 2 2002
W. Uhl
SUMMARY. Anastomotic leakage is the main factor (up to 30%) for postoperative morbidity and mortality after esophageal resection. Compromised anastomotic perfusion after dissection of supplying vessels for gastric tube formation and tension on the suture line are the two main reasons for anastomotic insufficiency. To prevent anastomotic leakage, a new technique for gastric tube formation after esophageal resection has been developed and introduced into surgical practice: the fundus rotation gastroplasty (FRG). The following paper summarizes rationale, technique and early results of this new technique. It is shown that the FRG is a safe and effective technique for esophageal reconstruction and offers important advantages over conventional gastroplasties: (i) the improved perfusion of the oral part of the tube; (ii) the gain of tube length allowing for a safer performance of even pharyngeal anastomosis as shown by the low insufficiency rate of 9%; and (iii) the increase of remaining gastric reservoir supporting physiologic stomach and gut function. Therefore, the FRG seems to be an alternative and safe method for esophageal reconstruction, especially for high anastomotic locations. [source]

End-to-end jejuno-ileal anastomosis following resection of strangulated small intestine in horses: a comparative study

EQUINE VETERINARY JOURNAL, Issue 4 2005
D. I. RENDLE
Summary Reasons for performing study: Small intestinal resection and anastomosis is a relatively common procedure in equine surgical practice. This study was designed to test objectively the subjective opinions of surgeons at the Liphook Equine Hospital that an end-to-end jejuno-ileal anastomosis (JIA) is an effective and clinically justifiable procedure, contrary to conventional recommendations. Hypothesis: An end-to-end JIA carries no greater risk of morbidity and mortality than an end-to-end jejunojejunal anastomosis (JJA). Methods: A retrospective observational study was performed on a population of 100 horses that had undergone small intestinal resection and end-to-end anastomosis. Two groups were identified; Group 1 (n = 30) had undergone an end-to-end JIA and Group 2 (n = 70) an end-to-end JJA. The 2 populations were tested for pre- and intraoperative comparability and for their equivalence of outcomes. Results: The 2 populations were comparable in terms of their distributions of preoperative parameters and type of lesion present. The observations used as outcome parameters (incidence risk of post operative colic, incidence risk of post operative ileus, duration of post operative ileus, rates of functioning original anastomoses at the time of discharge and at 12 months, survival rates at 6 months and 12 months) were equivalent between the 2 groups. Conclusion: End-to-end JIA carries no greater risk of morbidity and mortality than an end-to-end JJA. Potential relevance: Surgeons faced with strangulating obstructions involving the jejuno-ileal junction in which there remains an accessible length of viable terminal ileum may reasonably perform an end-to-end JIA. This has the potentially significant advantage over a jejunocaecal anastomosis of preserving more anatomical and physiological normality to the intestinal tract. The study was, however, relatively small for an equivalence study and greater confidence would be gained with higher numbers. [source]

Teaching oral surgery to undergraduate students: a pilot study using a Web-based practical course

EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 3 2003
Luciana Corrêa
The Internet has been used in oral surgery teaching mainly to deliver learning material across the World Wide Web and to make use of online interactivity resources in everyday surgical practice, such as by e-mails, discussion groups, and chats. The aim of this paper is to describe and evaluate a Web-based practical course on oral surgery principles, which was applied to undergraduate students. This course was investigated as a distance learning simulation in which the student would be performing surgical activities at home, and the teacher and the school environment would be absent. A Web site was created containing the course material. For this study, the students participated in the Web-based course in a multimedia lab equipped with computers and Internet, internal sound system and TV circuits. In the event of significant mistakes by students, the TV circuit could be used to show the correct procedure for all the participants at the same time. Microcameras were used to monitor the student's actions during the Internet use. Students' impressions were determined by a questionnaire. Computer manipulation with ease and antiergonomic postures were observed. We concluded that distance learning courses with practical modules must be considered as a special type of educational modality, with reference to the relationship between the student and the computer. [source]

Metastatic cancer to the floor of mouth: the lingual lymph nodes,,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2002
Jay M. Dutton MD
Abstract Background The upper level of a cervical lymphadenectomy is anatomically defined at its anterior extent by the lower border of the mandible and, in surgical practice, by the lingual nerve. A neck dissection completed below this level is generally considered adequate for removal of lymph nodes at risk for metastases from oral cavity cancer. Traditional discontinuous neck dissections do not provide for removal of floor of mouth tissue along with the primary and neck specimens. Methods A case report presenting biopsies from a T2N2bM0 squamous cell carcinoma of the mobile tongue and adjacent floor of the mouth in a 73-year-old man. Results Deep biopsy of a ventral tongue and floor of mouth squamous cell carcinoma revealed occult metastatic cancer to lymph nodes located in the superficial floor of mouth associated with the sublingual gland above the lingual nerve. This report identifies floor of mouth lymph nodes that can be involved with cancer and missed through the standard practice of discontinuous neck dissection.Conclusions. This finding offers evidence that, in certain cases, a traditional discontinuous neck dissection may not address all lymph nodes at risk in the treatment of oral cavity cancer. Further investigation into lymph node distribution within the oral cavity is warranted to reappraise the upper limits of cervical lymphadenectomy. © 2002 Wiley Periodicals, Inc. Head Neck 24: 401,405, 2002; DOI 10.1002/hed.10026 [source]

Targeting gold at the end of the rainbow: Surgical gamma probes in the 21st century

JOURNAL OF SURGICAL ONCOLOGY, Issue 4 2007
Frederick L. Moffat Jr MD
Abstract Surgical gamma detection probes (GDPs) have become important in the surgical management of neoplastic disease in the past 20 years. Their history and radiophysics are discussed, with consideration of the overarching issue of tumor-to-background ratio (TBR). GDPs are currently most commonly used in sentinel node applications in a variety of tumors. Whether their role in clinical surgical practice can be extended to other applications will depend on the development of radiolabeled tumor marking agents which have much improved TBR, and parallel developments in oncology research which may overtake this technology. J. Surg. Oncol. 2007;96:286,289. © 2007 Wiley-Liss, Inc. [source]

The Development of the Negative Pain Thoughts Questionnaire

PAIN PRACTICE, Issue 5 2008
Ana-Maria Vranceanu PhD
,,Abstract Background: Cognitive processes play a pivotal role in the perception of pain intensity, pain-related disability, and response to medical treatments including surgeries. While various measures of dysfunctional pain coping exist in the literature, there is no instrument available to examine such negative cognitions in relation to perceptions of medical treatment in pain patients presenting to a surgical orthopedics practice. Aims: The purpose of this article is to report on the development and preliminary testing of the Negative Pain Thoughts Questionnaire (NPTQ). Methods: The NPTQ is an 11-item questionnaire assessing cognitions about pain and its treatment in patients presenting to orthopedics surgical practices. It was administered to 2 samples of patients with hand and arm pain seeking medical treatment in a hospital surgical practice. Patients in the second sample also completed a measure of depression and one of disability of hand, arm, and shoulder. Results: The NPTQ was found to be internally consistent, and unidimensional. The NPTQ total score was found to have a moderate to high positive correlation with perceived hand, arm, and shoulder disability, and a moderate positive correlation with depression. In multivariate analyses, high scores on the NPTQ significantly predicted high perceived hand, arm, and shoulder disability, even after controlling for depression. Conclusion: This short and easily administered measure of negative pain thoughts could potentially help surgeons identify at risk patients, and facilitate referrals to cognitive behavioral therapy. This, in turn, may prevent unnecessary surgeries, may decrease healthcare costs, and prevent transition toward costly chronic pain syndrome.,, [source]

Breast Disease-Related Educational Outcomes at the University of Florida

THE BREAST JOURNAL, Issue 3 2000
D. Scott Lind MD
Abstract: The purpose of this study was to assess resident knowledge related to breast disease at the University of Florida. In addition, we surveyed graduates of our surgery program regarding the importance of breast disease in their surgical practice and we determined if the completion of postgraduate courses on breast disease influenced patient outcome measures. In the decade of the 1990s, we compared the American Board of Surgery In-Service Training Examination (ABSITE) scores of residents rotating on the breast service in the 6 months immediately prior to examination (June,January) with those residents who had not rotated on the breast service within the 6 months leading up to the ABSITE examination. We also compared ABSITE scores of surgery residents at the University of Florida at Gainesville (breast service) to surgery residents at the University of Florida at Jacksonville (no breast service). Finally, we surveyed graduates of the general surgery program at the University of Florida at Gainesville (1980,1998) to determine the importance of breast disease in their practices and if the completion of postgraduate courses on breast disease influenced rates of breast conservation and immediate breast reconstruction. Residents who rotated on the breast service in the 6 months prior to the ABSITE had significantly fewer incorrect breast-related ABSITE questions than residents who had not rotated on the breast service. Those graduates who had taken postgraduate courses in breast disease responded that they were more likely to perform breast,conserving surgery. There was also a trend for graduates who had completed postgraduate courses on breast disease to respond that they were more likely to perform immediate breast reconstruction following mastectomy. Limiting breast surgery to a single service does not appear to improve resident accumulation and retention of breast disease-related knowledge. Graduates who complete postgraduate courses related to breast disease are more likely to perform breast-conserving surgery and immediate reconstruction following mastectomy. Since the management of breast disease comprises a significant part of general surgical practice, surgical educators must ensure adequate resident education and evaluation with respect to breast disease. [source]

Robotics in cardiac surgery: the Istanbul experience

THE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 2 2006
Ertan Sagbas
Abstract Background Robots are sensor-based tools capable of performing precise, accurate and versatile actions. Initially designed to spare humans from risky tasks, robots have progressed into revolutionary tools for surgeons. Tele-operated robots, such as the da VinciÔ (Intuitive Surgical, Mountain View, CA), have allowed cardiac procedures to start benefiting from robotics as an enhancement to traditional minimally invasive surgery. Methods The aim of this text was to discuss our experience with the da Vinci system during a 12 month period in which 61 cardiac patients were operated on. There were 59 coronary bypass patients (CABG) and two atrial septal defect (ASD) closures. Results Two patients (3.3%) had to be converted to median sternotomy because of pleural adhesions. There were no procedure- or device-related complications. Conclusion Our experience suggests that robotics can be integrated into routine cardiac surgical practice. Systematic training, team dedication and proper patient selection are important factors that determine the success of a robotic surgery programme. Copyright © 2006 John Wiley & Sons, Ltd. [source]

The impact of intra-operative transoesophageal echocardiography on cardiac surgical practice

ANAESTHESIA, Issue 9 2009
A. A. Klein
Summary The use of transoesophageal echocardiography during cardiac surgery has increased dramatically and it is now widely accepted as a routine monitoring and diagnostic tool. A prospective study was carried out between September 2004 and September 2007, and included all patients in whom intra-operative echocardiography was performed, 2 473 (44%) out of a total of 5 591 cases. Changes to surgery were subdivided into predictable (where echocardiographic examination was planned specifically to guide surgery) and unpredictable (new pathology not diagnosed pre-operatively). A change in the planned surgical procedure was documented in 312 (15%) cases. In 216 (69%) patients the changes were predictable and in 96 (31%) they were unpredictable. The number of predictable changes increased between 2004,5 and 2006,7 (8% vs 13%, p = 0.025). In these cases, intra-operative echocardiography was specifically requested by the surgeon to help determine the operative intervention. This has implications for consent and operative risk, which have yet to be fully determined. [source]

rFV11a and paediatric open-heart surgery: thrombosis in the cardiopulmonary bypass circuit in spite of adequate markers of anticoagulation

ANAESTHESIA, Issue 6 2009
N. A. Chambers
Summary Recombinant activated factor V11 (rFV11a) is a relatively new procoagulant agent and its place in surgical practice continues to be investigated. We report the use of rFV11a to help manage bleeding in the operating theatre in a neonate, following weaning from cardiopulmonary bypass for arterial switch procedure, when bleeding continued in spite of maximal medical therapy and apparent exclusion of a surgical cause of bleeding. In this patient administration of rFV11a failed to facilitate haemostasis and cardiopulmonary bypass was re-instituted allowing location and repair of a small awkward surgical source. Separation from this additional 20 min of bypass was successful but a large thrombus was noted in the membrane oxygenator of the extracorporeal circuit in spite of the presence of adequate ,laboratory' markers of anticoagulation in the pump blood. No adverse sequelae to the patient occurred. [source]

Changing work patterns for benign upper gastrointestinal and biliary disease: 1994,2007

ANZ JOURNAL OF SURGERY, Issue 7-8 2010
Alexander P. M. Jay
Abstract Background:, The evolution of surgical technology has impacted on surgical practice. We determined trends in surgical caseload for common benign biliary and uppergastrointestinal conditions in Australia over the last 15 years. Methods:, Using the Medicare Australia web site, the use of Medicare item numbers specific to gall stone, bariatric and anti-reflux procedures were determined nationally and for each Australian state for each year from 1994 to 2007. Rates of operative cholangiography, laparoscopic to open cholecystectomy conversion and bile duct exploration were calculated. Per capita use of bariatric procedures was also determined. Anti-reflux surgery was analysed as total and specific subgroups of anti-reflux procedures. Results:, The use of intra-operative cholangiography has increased over time, and the conversion to open cholecystectomy and application of common bile duct exploration both decreased. A rapid increase in restrictive bariatric procedures has occurred, and this has been followed by a similar increase in revision bariatric surgery and lap band adjustments. The application of anti-reflux surgery has also increased significantly with the repair of large hiatus hernia accounting for most of the increase over the last five years, whereas revision anti-reflux surgery remains uncommon. Conclusions:, These data demonstrate significant increases in the application of some laparoscopic surgical techniques, particularly for morbid obesity. Future health-care planning will need to consider the impact of these changes. [source]

Why Taranaki women choose to have a mastectomy when suitable for breast conservation treatment

ANZ JOURNAL OF SURGERY, Issue 9 2009
Susan J. Gollop
Abstract Background:, Breast conservation treatment (BCT) rate is recognized as a marker of surgical practice. An historically low BCT rate may reflect the requirement for Taranaki women to travel for adjuvant radiotherapy. The aim of this study was to determine the reasons Taranaki women with breast cancer choose mastectomy or BCT. Methods:, Prospective information, on all women presenting with breast cancer between May 2004 and December 2006, was collected on a standardized questionnaire. Results:, BCT was offered to 68% (140 of 206), but chosen by only 46% (n = 64) of suitable patients. If radiotherapy had been available locally, 23% (17 of 73) of patients who chose mastectomy would have instead opted for BCT. A quarter of each group of women thought they knew their surgeon's treatment preference and most chose this option. Fear of local recurrence and need for further surgery were significantly more important to those choosing mastectomy over BCT whereas what the surgeon was perceived to prefer was more important to those choosing BCT. Conclusion:, The rate of BCT in Taranaki is low, despite it being offered by surgeons to the majority of patients. Local availability of radiotherapy may increase the BCT rate to a level more consistent with larger centres in New Zealand. Care must be taken to provide neutral patient guidance. [source]

ANALYSIS OF COMPLICATIONS FOLLOWING SURGICAL TREATMENT OF BENIGN PAROTID DISEASE,

ANZ JOURNAL OF SURGERY, Issue 3 2008
S. A. Reza Nouraei
Background: The objective of the study was to study the incidence of, and risk factors for developing complications following parotidectomy for benign disease, to improve preoperative patient counselling and better inform future surgical management. Methods: An 11-year retrospective review of 162 parotidectomies for benign disease, collecting and analysing data about presentation, investigations, surgical treatment, postoperative facial nerve function, Frey's syndrome and other surgical complications. Results: The mean age at presentation was 58 years. The commonest pathology was benign pleomorphic adenoma (43%), followed by Warthin's tumour (30%) and chronic sialadenitis (22%). Sialadenitis was a significant risk factor for facial nerve palsy and increased the incidence of salivary fistulas. Parotid duct ligation increased the risk of nerve palsy in the distribution of zygomatic and buccal branches. Operations for Warthin's tumour were associated with an increased risk of dysfunction of the cervical branch of the nerve. Half the patients had intraoperative facial nerve stimulation and this did not influence the likelihood of facial paresis. The recovery of facial nerve function showed a biphasic distribution, with 90% of patients having normal function within 12 months, followed by a slower recovery rate for up to 2 years. Conclusion: The incidence of postoperative complications was influenced by the pathology, with inflammatory lesions significantly increasing the risk of facial nerve dysfunction and other complications, but also by variations in surgical practice, such as parotid duct ligation. Overall, the incidence of permanent facial paralysis was less than 2%, but temporary nerve palsy was common at 40%, with most patients regaining normal function within 1 year of the operation. [source]

LAPAROSCOPIC CHOLECYSTECTOMY: AN AUDIT OF OUR TRAINING PROGRAMME

ANZ JOURNAL OF SURGERY, Issue 4 2005
Swee Ho Lim
Background: Laparoscopic cholecystectomy is a commonly performed procedure in general surgical practice but it also has an inherently steep learning curve. The training of surgeons in this procedure presents a challenge to teaching hospitals, which essentially have to strike a balance between effective training and safety of the patient. The present study aims first to assess the safety of the structured training programme for this procedure at the Department of Surgery, Changi General Hospital, Singapore. Secondly, it seeks to audit the conversion and bile duct injury rates among the laparoscopic cholecystectomies performed by the department, and the factors which influence these. Methods: Notes of all patients who underwent laparoscopic cholecystectomy in the department over an 18-month period were reviewed retrospectively and the relevant data prospectively collected. Demographics, as well as details of cases of conversion to open operation and of bile duct injury were identified and the reasons for each recorded. Results: A total of 443 patients underwent laparoscopic cholecystectomy in the 18-month period. The most common indication for surgery was biliary colic/dyspepsia (61.4%), followed by cholecystitis, cholangitis, pancreatitis and common bile duct stone. The overall conversion rate was 11.5%. Three hundred and fifty-five patients were operated on by consultant surgeons, while 88 were by registrars who had been through the structured training programme. There was no statistically significant difference found in the conversion rates between these two groups (P = 0.284). Twenty-two of the 268 female (8.2%) patients had conversion to open operation, while 29 of the 175 male patients (16.6%) underwent conversion (P = 0.007). Amongst cases of cholecystitis and cholangitis, the conversion rate for patients operated on within 7 days of onset of symptoms was 35%, while those operated on 8 or more days later had a conversion rate of 29.7% (P = 0.639). There was a solitary case of bile duct injury among the 443 cases, equating to a bile duct injury rate of 0.23%. Conclusion: A structured training programme involving stepwise progression of training, with close supervision by consultant surgeons and a built-in system of audit can effectively train junior surgeons in laparoscopic cholecystectomy without exposing patients to undue risks. [source]

EARLY EXPERIENCE WITH CLINICAL INDICATORS IN SURGERY

ANZ JOURNAL OF SURGERY, Issue 6 2000
B. T. Collopy
Background: In 1997 a set of 53 clinical indicators developed by the Royal Australasian College of Surgeons (RACS) and the Australian Council on Healthcare Standards (ACHS) Care Evaluation Programme (CEP), was introduced into the ACHS Evaluation and Quality Improvement Programme (EQuIP). The clinical indicators covered 20 different conditions or procedures for eight specialty groups and were designed to act as flags to possible problems in surgical care. Methods: The development process took several years and included a literature review, field testing, and revision of the indicators prior to approval by the College council. In their first year 155 health-care organizations (HCO) addressed the indicators and this rose to 210 in 1998. Data were received from all states and both public and private facilities. Results: The collected data for 1997 and 1998 for some of the indicators revealed rates which were comparable with those reported in the international literature. For example, the rates of bile duct injury in laparoscopic cholecystectomy were 0.7 and 0.53%, respectively; the mortality rates for coronary artery graft surgery were 2.5 and 2.1%, respectively; the mortality rates after elective abdominal aortic aneurysm repair were 2.5 and 3.7%, respectively; and the post-tonsillectomy reactionary haemorrhage rates were 0.9 and 1.3%, respectively. Results for some indicators differed appreciably from other reports, flagging the need for further investigation; for example, the negative histology rates for appendectomy in children were 18.6 and 21.2%, respectively, and the rates for completeness of excision of malignant skin tumours were 90.7 and 90%, respectively. The significance of these figures, however, depends upon validation of the data and their reliability and reproducibility. Because reliability can be finally determined only at the hospital level they are of limited value for broader comparison. Conclusion: The process of review established for the indicator set has led to refinement of some indicators through improvement of definitions, and to a considerable reduction in the number of indicators to 29 (covering 18 procedures), for the second version of the indicators (which was introduced for use from January 1999). The clinical indicator programme, as it has with other disciplines, hopefully will provide a stimulus to the modification and improvement of surgical practice. Clinician ownership should enhance the collection of reliable data and hence their usefulness. [source]

Natural orifice surgery: applications in colonic surgery

ASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 2 2010
J. Leroy
Abstract Natural orifice transluminal endoscopic abdominal surgery, or NOTES, allows invasive operations to be performed through a single or multiple natural-orifice approach either in isolation ("pure") or in combination with a transparietal ("hybrid") access format. Therefore, to facilitate a colonic or rectal resection, the transgastric, transrectal or transcolonic routes, as well as the transvaginal route in women, can all be used either alone or in combination. We are now performing resectional colonic techniques on our patients that have been inspired by this revolutionary concept, carefully planned with storyboarding and validated in porcine models with survival analysis. Adaptation of existing equipment along with the use of new instruments and some simple ideas, such as magnetic fields to retract and mobilize the colon, have allowed us to simplify and standardize the operative technique (the first steps to ensuring procedural reproducibility). Initial potential applications can easily be imagined for partial colonic resections for voluminous benign polyps and for small early cancers, but these applications may extend to incorporate inflammatory bowel diseases such as diverticular disease of the sigmoid colon. For these techniques to further improve and the concept to become a concrete reality, a change in current surgical practice is required, and conventional laparoscopic techniques must be understood to represent a point along the evolutional development of surgery and not considered the final destination. However, as important as technical capacity is, due consideration and assurance of oncological and immunological propriety is essential, as is the issue of clarifying precise patient harm:benefit risk ratios. [source]

Training in minimally invasive surgery: An Asian perspective

ASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2009
D Lomanto
Abstract Minimally invasive surgery, which requires a different approach than used in the past, has created a revolution not only in surgical practice but also in surgical education. To overcome the challenges and difficulties of minimally invasive surgery, training needs to be done outside the operating room and away from the patient. New educational tools have emerged in the form of surgical simulators, including trainer boxes, virtual reality simulators and hybrid simulators. Many studies have confirmed the effectiveness of both box trainers and virtual reality simulators for surgical education. The integration of simulators into a structured laparoscopic skills curriculum creates an ideal training ground for acquiring the necessary skills for minimally invasive surgery. It has also been proven that this training model is effective for transferring acquired skills into the clinical setting. [source]

Civiale, stones and statistics: the dawn of evidence-based medicine

BJU INTERNATIONAL, Issue 3 2009
Harry W. Herr
The statistical research on bladder stones conducted by Paris urologist Jean Civiale in the early 19th century provided historical roots for evidence-based medicine. Translations of original documents by Civiale describing his work on treating bladder stones, and the discussion by members of the Paris Academy of Sciences that commented on his results in 1835, were reviewed. By collecting statistical data on a wide scale throughout Europe, Civiale argued that his new transurethral procedure, called lithotripsy, was superior to the more widely used but highly morbid technique, lithotomy. The Paris Academy of Sciences commented on his research and chose the occasion to debate whether or not numerical reasoning and statistics had any place in medical and surgical practice. Civiale's insights and methods espoused similar concepts and ideas driving today's new paradigm of evidence-based medicine. [source]

Antiangiogenic therapy and surgical practice (Br J Surg 2008; 95: 281,293)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2008
I. J. CohenArticle first published online: 11 JUL 200
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and,if approved,appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Authors' reply: Antiangiogenic therapy and surgical practice (Br J Surg 2008; 95: 281,293)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2008
A. R. John
No abstract is available for this article. [source]

Emergency vascular and endovascular surgical practice.

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2006
2nd edn.
No abstract is available for this article. [source]

Ethics in surgical practice

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2001
This is the first in a series of articles on ethics, professional governance, the law that BJS will run through the remainder of 2001.
No abstract is available for this article. [source]

Litigation and surgical practice in the UK,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2000
H. Goodwin
No abstract is available for this article. [source]

Engineering of bypass conduits to improve patency

CELL PROLIFERATION, Issue 5 2004
S. T. Rashid
It has been decades since any real progress in bypass material has reached mainstream surgical practice. This review looks at possible remedies to this situation. Options considered are methods to reduce prosthetic graft thrombogenicity, including endothelial cell seeding and developments of new prosthetic materials. The promise of tissue-engineered blood vessels is examined with a specific look at how peptides can improve cell adhesion to scaffolds. [source]

The uptake of laparoscopic colorectal surgery in Great Britain and Ireland: a questionnaire survey of consultant members of the ACPGBI

COLORECTAL DISEASE, Issue 3 2009
K. E. Schwab
Abstract Objective, The National Institute for Clinical Excellence (NICE) has recommended laparoscopic resection as an alternative to open surgery for patients with colorectal cancer. The aim of this study was to evaluate the current uptake of laparoscopic colorectal surgery in Great Britain and Ireland. Method, A questionnaire was distributed to members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) regarding their current surgical practice. Results were analysed individually, by region, and nationwide. Results, Information was received on 436 consultants (in 155 replies), of whom 233 (53%) perform laparoscopic colorectal procedures. During the previous year, 25% of colorectal resections were performed laparoscopically by the respondents. However, of those surgeons who were performing laparoscopic resections, only 30% performed more than half of all their resections laparoscopically. Right hemicolectomy, left-sided resections, and rectopexy were the most frequently performed laparoscopic resections. There was an even distribution throughout the country of consultants performing laparoscopic resections (regional IQR 48,60%). The main reason for consultants not performing laparoscopic procedures was a lack of training or funding. Conclusion, Laparoscopic colorectal surgery is being performed by more than half (53%) of colorectal consultants nationwide, although only a quarter of all procedures are being undertaken laparoscopically. [source]