Chief Surgeon Research Articles

A tale of surviving three consecutive cardiorespiratory arrests on table during a right sided pneumonectomy.

Intraoperative cardiorespiratory arrest secondary to lower airway obstruction is often difficult to manage. We describe the management of one such technically challenging case of three consecutive cardiorespiratory arrests during a right pneumonectomy in a young boy. A 10 years boy with a large fleshy vascular endobronchial tumor (biopsy proven squamous papilloma), completely occluding the right main-stem bronchus with collapse-consolidation of underlying right lung, was posted for a right pneumonectomy. There were dense adhesions of lung to the parieties and the lung was completely damaged. Twenty-five minutes into the surgery, patient started desaturating and the anesthetist was having difficulty in ventilating him. Check bronchoscopy showed endobronchial bleeding and the double lumen tube abutting the tumor. He was turned supine and CPR performed along with suctioning of blood and repositioning of tube. Patient revived and surgery continued. One and a half hour into the surgery the boy had a second cardiorespiratory arrest due to similar airway obstruction and managed in similar fashion. Lower lobectomy was speedily done to gain access to the hilum followed by quick completion pneumonectomy. Immediately following specimen removal, the patient had the third cardiorespiratory arrest and anesthetist was unable to ventilate the patient even after suctioning and repositioning of tube. With patient in lateral position, through the thoracotomy, right bronchial stump was opened and a quick bronchial intubation performed by the surgeon in chief. On opening the bronchus a tumor ball was seen occluding the left main bronchus, which probably got detached from the main tumor during pneumonectomy. Residual tumor was delivered out and the bronchial stump closed. Patient was transferred to ICU on ventilatory support. Postoperatively he was extubated after 48 hours and was found to have no neurological deficit. Chest drain came out on POD2 and he was discharged on POD5. Promptly and methodically addressing this technical challenge helped us to prevent mortality. We also managed to avoid neurological sequelae of cardiorespiratory arrest. Learning point in this case is that when faced with a similar situation, it's important to stay calm and focused and to handle the challenge in a scientific and logical manner.

N.N. Burdenko is chief surgeon of Soviet Army(by 140th anniversary)

N.N. Burdenko is chief surgeon of Soviet Army(by 140th anniversary)

Observations from home: The patient centered medical home, integrated behavioral healthcare, teams and teamwork.

Medicine is no longer a single's game, it's a team sport. Long true in surgical specialties where the operative effort led by the chief surgeon is a carefully choreographed ballet of surgical assistants, surgical nurses, anesthesiologist, and other technical staff, now medical subspecialists are also assisted by teams composed of advanced practice nurses, physician assistants, social workers, and pharmacists. In primary care, the new vehicle for care teams is the Patient Centered Medical Home (PCMH; Kellerman & Kirk, 2007), which is designed to serve 85%-90% of patients' needs with the broadest "basket of services" possible.

Evaluation of fine particles in surgical smoke from an urologist's operating room by time and by distance.

Electrocautery, harmonic scalpel tissue dissection and other surgical techniques can generate surgical smoke with high proportion of 'fine particles' (PM(2.5)) <2.5 μm, which is known to have adverse effects on human health. The high-risk zone for PM(2.5) during surgeries by time and by distance has not been well evaluated. The study included open superficial, open abdominal, open pelvic, laparoscopic and transurethral urology surgeries, five of each. A particle counter was placed at three different distances from the incision site, and the real-time PM(2.5) concentration was displayed after each cut. Air Quality Index (AQI) revised by the US Environmental Protection Agency and the calculated inhalation dose were used to evaluate the severity of PM(2.5). In superficial, abdominal and pelvic surgeries, the peak PM(2.5) concentration may reach 245.7, 149.4 and 165.1 μg/m(3) 3-6 s after a single cut 40 cm from the incision site. By the time, AQI usually turns to 'unhealthy' or 'very unhealthy.' In laparoscopic surgeries, 40 cm from the trocar, the air quality reached 'hazardous' in 3 s after opening of the trocar valve with a peak concentration of 517.5 μg/m(3). In transurethral surgeries, the AQI 40 cm away from the resectoscope is generally at moderate level. In each surgery, the chief surgeon may inhale most of the PM(2.5), while the assistant will inhale less than half the dose, and the scrub nurse may inhale nearly none. The use of wall suction may induce a 48-65 % decrease in fine particle inhalation. During surgeries, the concentration of PM(2.5) could reach a very unhealthy status, especially for the chief surgeon who is the nearest to the incision site. Surgical smoke evacuation in the first few seconds of a cut is essential; however, using smoke evacuators such as a wall suction alone may not be enough.

Discovery of Functional Serum Biomarkers

Clinical OMICsVol. 2, No. 2 CASE STUDYDiscovery of Functional Serum BiomarkersXing Wang, Zhenyu Sun, Xiaofeng Chen, Xiong Su, Gan Wang, and Matthew KurucXing WangXing Wang, Ph.D., is president of Array Bridge. (E-mail Address: xing.wang@arraybridge.com) Zhenyu Sun, M.D., is chief surgeon at Nantong University School of Medicine Wuxi No. 3 Hospital. Xiaofeng Chen, M.D., is chief surgeon at Shanghai Huashan Hospital, Fudan University School of Medicine. Xiong Su, Ph.D., is a professor at Soochow University Medical College, China. Gan Wang, Ph.D., is an associate professor at the Institute of Environmental Health Sciences, Wayne State University. Matthew Kuruc is vice president for business development at Biotech Support Group.Search for more papers by this author, Zhenyu SunSearch for more papers by this author, Xiaofeng ChenSearch for more papers by this author, Xiong SuSearch for more papers by this author, Gan WangSearch for more papers by this author, and Matthew KurucSearch for more papers by this authorPublished Online:3 Sep 2015https://doi.org/10.1089/clinomi.02.02.10AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 2Issue 2Feb 2015 InformationCopyright © GEN PublishingTo cite this article:Xing Wang, Zhenyu Sun, Xiaofeng Chen, Xiong Su, Gan Wang, and Matthew Kuruc.Discovery of Functional Serum Biomarkers.Clinical OMICs.Feb 2015.22-24.http://doi.org/10.1089/clinomi.02.02.10Published in Volume: 2 Issue 2: September 3, 2015PDF download

Reducing radiation exposure during kyphoplasty with the use of a remote control injection system: a prospective study.

A prospective study. To compare surgeons' radiation exposure during kyphoplasty with and without the use of a remote control injection system. Distance from radiation sources is a critical factor for reducing radiation exposure during spine surgery. A newly designed device was used to minimize operators' radiation exposure during kyphoplasty. Forty-four patients admitted for single-level osteoporotic vertebral compression fracture were randomly divided into 2 groups (groups A and B) and treated with kyphoplasty. The remote control injection system was used only in group B. The radiation doses to the surgeon's eyes, thyroid, chest, and right wrist were recorded with 4 unprotected radiometers simultaneously. Operation time, fluoroscopic time, cement amount, patient-reported pre- and postoperative visual analogue scale scores for pain, and complications were recorded. For group A, the radiation doses at the eyes, thyroid, and right wrist were 1.132 ± 0.104 mSv, 0.647 ± 0.049 mSv, 0.578 ± 0.056 mSv, and 1.877 ± 0.214 mSv, respectively; for Group B, these doses were 0.257 ± 0.067 mSv, 0.201 ± 0.049 mSv, 0.145 ± 0.033 mSv, and 0.353 ± 0.046 mSv, respectively (P < 0.05). Comparisons of the radiation doses the chief surgeon and the resident surgeon received showed that the resident surgeon received more radiation during group A procedures; during group B procedures, the surgeons received similar doses. The proportion of average fluoroscopic time devoted to the bone cement injection step for groups A and B was 64% and 63%, respectively, and the average proportion of the radiation doses that were received during the bone cement injection step was 66% for group A and 36% for group B. Compared with the preoperative visual analogue scale score, the postoperative visual analogue scale score was significantly reduced in both groups. During kyphoplasty, the use of the remote control injection system can significantly reduce surgeons' radiation exposure without affecting the efficiency of procedures.

The Creation of the Canadian Connective Tissue Conference (CCTC): Twenty Years on.

Background When I arrived in Canada in 1977 to establish and direct the Joint Diseases Laboratory at the Shriners Hospital, McGill University, I came from a strong background in connective tissue research in Britain. Originally, in the 1960s, we had national Collagen,Mucopolysaccharide and the Bone and Tooth interest groups that each met regularly and separately. Eventually, the first two groups merged to form the British Society for Matrix Biology. This was and continues to be a very important society as it provides a common meeting ground for students and scientists interested in connective tissue research where progress is shared and collaborations are forged and new training and job opportunities explored. But on arrival in Canada there was very little research in this fundamentally important area. Tony Melchers MRC group in periodontal physiology, that included Jaro Sodek, based in Toronto, was the only group of its kind at that time. There were researchers working on small soft tissue proteoglycans, in Edmonton, Alberta, namely Paul Scott and Carl Pearson; C.P Leblond and his colleagues at McGill who had contributed so much to our understanding of connective tissues and developmental biology, their work inspiring us all. Michel van der Rest was working on collagen in the adjacent Genetics Laboratory at the Shriners Hospital. Dick Cruess, chair of orthopaedics at McGill and Chief Surgeon at Shriners Hospital, who had invited me to start a group at the Shriners Hospital, and his colleague Nelson Mitchell, both based at the Royal Victoria Hospital, were involved in research on joint tissues. They were excellent early role models for the surgeon/ scientist. A number of arthritis researchers were scattered across Canada, mainly with interests in inflammatory arthritis. Connective tissues were never mentioned. Following my arrival, my contacts were mainly with Tony Melcher’s group and laboratories in the USA where there already existed a very strong community of outstanding connective tissue researchers, especially those working on cartilage. These included Larry Rosenberg in NewYork, who gave up orthopaedics to pursue his passion-research on proteoglycans, and Vince Hascall at NIH (proteoglycans) and David Howell and Fred Woessner in Miami (proteases and proteoglycans). Meanwhile Peter Roughley (proteoglycans), John Mort and Anneliese Recklies (proteases) and Elaine Golds (inflammation/cytokines) had joined me in Montreal. Interest in connective tissues had grown progressively in Toronto, with Ken Pritzker working on osteoarthritis, the arrival of Marc Grynpas (bone) from Boston and Rita Kandel (cartilage). Meanwhile, in the early 1980s, Cy Frank, a young orthopaedic surgeon, also with a passion for research, had established a research program in Calgary that would involve orthopaedics, rheumatology, cartilage, tendon, ligament, proteases and bioengineering. By the beginning of the 1990s, Canada had many connective researchers. But they rarely met. Our main meetings were south of the border, such as the Orthopaedic Research Society, or in Europe. There were no opportunities for Canadian scientists and young researchers to meet on a regular basis, and for trainees to seek guidance and explore further training and job opportunities in Canada. I knew of many young researchers moving to the states, often never to return, often because of the lack of a Canadian meeting place.

Reduced-Port Distal Gastrectomy for Gastric Cancer Using Two Needle Devices, a GelPOINTTMDevice, and an Umbilical Zigzag Incision

Introduction: Single-incision laparoscopic surgery (SILS) and reduced-port surgery (RPS) have been introduced to provide better cosmetic effects and decrease postoperative pain and incision-related complications. In recent years, SILS and RPS procedures have been increasingly applied for a variety of abdominal surgeries, including cholecystectomy, appendectomy, and colectomy. However, it can be difficult to maintain triangulation and proper organ retraction because of the inadequate distance between instruments and the small number of access ports, respectively. In terms of gastrectomy for gastric cancer, which is associated with technical difficulties even with the conventional laparoscopic approach, SILS and RPS have not been applied widely. To resolve these problems, we devised a novel procedure of reduced-port gastrectomy for gastric cancer using two needle devices and the GelPOINT™ with an umbilical zigzag incision.1,2 In this video, we demonstrate reduced-port laparoscopic distal gastrectomy. Materials and Methods: A 64-year-old woman with early gastric cancer in the lower body of the stomach underwent laparoscopic distal gastrectomy with D1+ lymphadenectomy. After placing an umbilical zigzag skin incision measuring 3.5 cm, a GelPOINT was placed through the incision. The laparoscope and two conventional instruments were inserted through the GelPOINT. Two additional needle devices (Endo-Relief; Hope Electronics)3 were inserted in the right and left upper abdomen, with shaft diameter of 2.4 mm and tips of the same shape and size as those of the 5-mm-diameter instruments. The chief surgeon was positioned on the patient's right side, and he used the needle device in the right abdomen with his left hand and the instrument inserted through the GelPOINT with his right hand. The first assistant on the patient's left side used the left needle device with his right hand and another instrument through the GelPOINT with his left hand. Results and Conclusions: Distal gastrectomy with lymphadenectomy was performed using the same technique as that used for conventional five-port laparoscopic distal gastrectomy. After removal of the resected specimen through the umbilical incision, reconstruction was performed with the Roux-en-Y method. The umbilical incision was closed with absorbable sutures, and no sutures were required for the other two needle incisions. The total operative time was 329 minutes, and blood loss was minimal. There were no intraoperative or postoperative complications, and the patient was discharged 10 days after the surgery. Our reduced-port gastrectomy procedure has three key features. First, the 3.5-cm umbilical zigzag skin incision provides a sufficiently wide opening to prevent the instruments from clashing. The scar is well hidden and inconspicuous in the umbilicus. Second, by using Endo-Relief needle devices, which can be used as conventional laparoscopic instruments, postoperative pain is minimized and the two wounds outside the umbilicus are almost invisible several months after the surgery. Third, each surgeon has sufficient distance between instruments to maintain good triangulations. Taken together, this novel procedure permits safe and feasible reduced-port gastrectomy, similar to conventional laparoscopic gastrectomy, and provides excellent cosmetic results and decreased postoperative pain, resulting in almost SILS. No competing financial interests exist. Runtime of video: 6 mins 32 secs

Basic investigation into the present burn care system in China: Burn units, doctors, nurses, beds and special treatment equipment

ObjectiveThe aim of the study was to survey the current burn units in China to understand the burn care system in the country and supply basic data for the National Burn Repository of China (NBRC) and further research. MethodA questionnaire was developed and sent to burn unit directors in China via e-mail, which was followed up with reminder text messages to obtain information for the study. ResultsOf the 405 hospitals from the 31 provinces in mainland China that responded to the questionnaire, 63.7% of the responses came from Grade 3A hospitals, and the most popular model of organisation was the Burns and Plastic Surgery arrangement (63.0%). An average of 9.43±0.351 doctors work in each burn unit with 70.4% of all units having 4–11 doctors. The ratio of chief surgeon to associate chief surgeon to attending surgeon to resident surgeon and surgeon assistant was 1:1.8:2.2:2.3. An average of 30% of all doctors in each burn unit held postgraduate degrees, and more than 90% of all surgeons held a bachelor's degree or higher. There were 16.48±0.637 nurses per burn unit, 56.5% of burn units had 8–15 nurses, and the ratio of chief nurse to associate chief nurse to supervisor nurse to nurse practitioner to junior nurse was 1:11.8:57.0:82.1:86.1. More than 80% of all nurses had received a college education or above. However, only 30% of nurses held bachelor's degrees or higher, while only 0.66% of nurses had received postgraduate degrees. A total of 39.91±1.50 beds were available in each burn unit and 45% of burn units had 20–39 beds. Up to 70% of the total beds were prepared for patients with burn, and more than 10% of the beds were specifically for patients with severe burn. The ratios of doctors to nurses, beds to doctors, beds to nurses, and beds to doctors and nurses were 0.64±0.01, 4.48±0.12, 2.67±0.09, and 1.66±0.06, respectively. The workload of each doctor and nurse was most heavy in units with 40–59 beds. In addition, we estimated that there were 0.05, 0.5, 0.8, and 1.9 burn units, burn doctors, nurses, and beds, respectively, per 100,000 members of the population in mainland China. Chinese burn units lack special burn treatments, nursing equipment, and operation apparatuses. ConclusionTo the best of our knowledge, this is the first survey of the present burn care system in China. These results confirm that the burn care system is not equivalent to the national power of this country and the system lacks a great number of trained burn professionals. Burn doctors and nurses bear a heavy burden of work. This report supplies basic data to spur further research. We propose creating a burn unit registration system and a special database in China.

Major Harvey Cushing's difficulties with the British and American armies during World War I.

This historical review explores Harvey Cushing's difficulties with both the British and American armies during his World War I service to definitively examine the rumor of his possible court martial. It also provides a further understanding of Cushing the man. While in France during World War I, Cushing was initially assigned to British hospital units. This service began in May 1917 and ended abruptly in May 1918 when the British cashiered him for repeated censorship violations. Returning to American command, he feared court martial. The army file on this matter (retrieved from the United States National Archives) indicates that US Army authorities recommended that Cushing be reprimanded and returned to the US for his violations. The army carried out neither recommendation, and no evidence exists that a court martial was considered. Cushing's army career and possible future academic life were protected by the actions of his surgical peers and Merritte Ireland, Chief Surgeon of the US Army in France. After this censorship episode, Cushing was made a neurosurgical consultant but was also sternly warned that further rule violations would not be tolerated by the US Army. Thereafter, despite the onset of a severe peripheral neuropathy, probably Guillian Barré's syndrome, Cushing was indefatigable in ministering to neurosurgical needs in the US sector in France. Cushing's repeated defying of censorship regulations reveals poor judgment plus an initial inability to be a "team player." The explanations he offered for his censorship violations showed an ability to bend the truth. Cushing's war journal is unclear as to exactly what transpired between him and the British and US armies. It also shows no recognition of the help he received from others who were instrumental in preventing his ignominious removal from service in France. Had that happened, his academic future and ability to train future neurosurgical leaders may have been seriously threatened. Cushing's foibles notwithstanding, all realized that he contributed greatly to both British and US war neurosurgery. United States Army surgeons who operated upon brain wounds in France recognized Cushing as their leader.

Left-Side Hepatectomy in Living Donors: Through a Reduced Upper-Midline Incision for Liver Transplantation

BackgroundWe present our attempts at reducing the length of incision in living donor left-side hepatectomy without laparoscopic approach. MethodsThe chief surgeon initially made a 10-cm upper midline incision and performed all procedures through a minilaparotomy without abdominal wall lifting or pneumoperitoneum. For the procedures in the lateral and deep areas, we effectively applied traction to the wound in multiple directions using a wound retraction system so that the chief surgeon could obtain a good direct view. We also placed a fiberscope on the minilaparotomy so that the assistant surgeons could obtain an additional video view via a monitor. Surgeons lengthened the incision at their own discretion if the initial length was thought to be too short for the donor's safety. Since February 2009, we have employed this operation for 19 living donors (12 lateral segmentectomies and 7 left hepatectomies) and compared parameters between the 19 donors and 34 previous donors who underwent the procedure with standard incision (11 lateral segmentectomies and 23 left hepatectomies). ResultsThe resultant length of incision was significantly reduced in operations with reduced incision length as compared with standard incision. Clinical outcomes such as operation time and length of hospital stay were comparable or significantly reduced with the reduced incision. The resultant incision length remained within 10 and 12 cm in lateral segmentectomy and left hepatectomy cases, respectively, whose body mass index was less than 22. ConclusionIt appears to be feasible to reduce the incision length for living donor left-side hepatectomy, especially in nonobese cases.

Initial Surgery for Benign Primary Hyperparathyroidism: An Analysis of 1,300 Patients in a Teaching Hospital

Success rates of initial surgery for primary hyperparathyroidism (pHPT) are greater than 95 % in specialized centers, mostly referring to single-surgeon experiences. The present study was performed to identify changes in clinical manifestations, diagnostic procedures, surgical strategies, and outcome of initial parathyroid interventions in a teaching hospital during the past 25 years with special regard to the surgical expertise. Clinical data of patients who underwent an initial neck exploration for benign pHPT between 1985 and 2010 at the University hospital Marburg were retrospectively evaluated. All data were analyzed particularly with regard to the implementation of additional pre- and intraoperative procedures and to the particular surgical strategy. In addition, operative results were furthermore analyzed with regard to the experience of the responsible surgeons. An initial neck exploration for benign pHPT was performed in 1,300 patients. Of these, 1,035 patients had a bilateral cervical exploration (BCE) and 265 patients had a focused, minimally invasive parathyroidectomy (MIP). Cure rates did not differ between focused surgeries and BCE (98.9 vs. 98.3%, p = 0.596) after a mean follow-up of 33.4 (± 44.3) months. Postoperative transient hypoparathyroidism was significantly lower in the MIP group (11 vs. 47%, p < 0.0001). The rate of permanent recurrent laryngeal nerve palsies (0.4 vs. 2%, p = 0.064) and nonsurgical complications (0 vs. 1.4%, p = 0.0875) tended to be lower in the MIP group. Success and complication rates of chief surgeons (n = 2), attending surgeons (n = 20), and residents (56 < 3 years, 30 > 3 years) were similar, despite a significantly shorter operating time in the chief surgeon group (p < 0.01). Despite the implementation of several diagnostic procedures and significant changes concerning the surgical strategy, high success rates of primary interventions for pHPT did not change over the past three decades. High success rates also can be achieved in a teaching hospital, provided that surgery is supervised by an experienced endocrine surgeon. MIP is the treatment of choice in patients with benign sporadic pHPT and positive preoperative localization studies.

Instructions in the operating room: How the surgeon directs their assistant’s hands

This article deals with surgical practice as it is locally organized within the course of the operation; it focuses on the way in which surgical action shaping the body for the local purposes of the operation is organized in a timely, situated, interactive manner. In order to do that, I offer a systematic analysis of the instructions addressed by a chief surgeon to his assistant in the form of directives during a surgical operation, as well as of instructed actions of the assistant following the directives of the surgeon. In this way, I aim to show how surgery is a methodic collaborative achievement, relying on finely tuned coordination between staff members. More generally, the article sketches a systematic and detailed analysis of instructions as situated accomplishments in time, and of instructed action as resulting from an embodied and indexical understanding of directives and requests as they are produced in time and in context.

Chance will find a talented person: Philipp Jakob Karell

Many people of Estonian ethnicity have found their way out of poverty by chance. Chance will favour the ambitious and hard-working and give them an opportunity to realise their dreams. Several examples can be found among Estonian scientists and cultural figures as well. One of those was Philipp Jakob Karell.Philipp Jakob Karell, who came from of a family of peasant servants of an estate, graduated from the Medical Faculty of the University of Tartu in 1832 with the doctoral dissertation De rheumatismo uteri, and after graduation from the university, a piece of good luck gave the hard-working young man a chance to go to work in Saint Petersburg where, in 1849, he became the physician in ordinary to the Emperor’s family. He was the escort of Emperor Nicholas I on his travels both in Russia and abroad. Empress Alexandra Feodorovna was also Karell’s patient, and Alexander II also named him his physician in ordinary.On his first travel abroad, he learned the use of starch casts for the treatment of bone fractures from L. Seutin, chief surgeon of Brussels Saint Peter’s Hospital, and in 1837 started to use them himself in the hospital of the Life Guards Cavalry Regiment.When the Dutch physician Baron C. Heurteloup visited Russia, Philipp Karell was his companion and operating assistant in both Saint Petersburg and Moscow. Ph. Karell summarized what he had learned during the operations in the article “Vollständige Beschreibung von Baron Heurteloups Lithotripsie und Lithokenose durch Percussion, nach dessen eigenen mündlichen Mittheilungen und Papieren”, noting among other things that non-physicians should also recognize the initial symptoms of stone diseases (nephrolithiasis, cholelithiasis).Karell’s method of milk therapy where skimmed milk had to be consumed after fixed time intervals, starting from 0.5–1.0 coffee cups 3–4 times a day and reaching two bottles a day on the second week, brought him international recognition. With the method of milk therapy, he achieved good results primarily in the treatment of diseases, connected with disturbances of water balance (cardiac, renal, gastrointestinal and liver diseases, and overweight).Ph. Karell was also active in the foundation of the Russian Red Cross Society, participated in drafting of its statutes and belonged to its committee. He was also among the founders of the Russian Society of Surgery. On Karell’s initiative, sanitary companies were created in the Russian Army.Although he worked in the Emperor’s court, Ph. Karell always remained an Estonian and repeatedly helped to acquire money from the Emperor for Estonian undertakings. He helped to publish the Estonian national epic Kalevipoeg (Son of Kalev) and always valued his friendship with F.R. Kreutzwald and N. Pirogov, which had started during his university days.

Perpetuating proficiency in donor right hepatectomy for living donor liver transplantation

Donor right hepatectomy (DRH) was developed by master liver surgeons and has been applied in many liver transplant centers as the mainstay for adult living donor liver transplantation. It is a major and complex surgical operation performed on living liver donors for the benefit of liver recipients. The donors deserve the lowest though inevitable morbidity and mortality. In this study, the surgical outcomes of DRH performed by newer surgeons at an established center were studied to assess the transferability of the techniques of this standardized procedure. We studied 450 consecutive DRHs performed by 11 surgeons. Three surgeons initiated and developed the transplant program and performed the first 200 DRHs (Era I). The role of chief surgeon in the following 250 DRHs (Era II) was gradually taken up by four newer surgeons with close guidance initially. Blood loss and operation time at the end of Era I versus the beginning of Era II were 251 vs. 341mL and 391 vs. 497minutes. The learning curve effect in Era I did not occur in Era II. The complication rates of the last 50 cases in Era I and Era II were 16% and 24%, respectively. Era I had one donor death whereas Era II had no donor death. At an established center, DRH can be carried out safely by newer surgeons with good outcomes.

Austrittsvorbereitung: Selbstpflegekompetenz fördern bei Patient(inn)en nach minimal-invasiver Hüftendoprothetik

Increasing numbers of hip replacement implant surgeries in Switzerland today are minimally invasive. Patients undergoing such procedures become mobile faster and are discharged from hospital to home within an average of four days. Using a qualitative descriptive design, this study examined how post-operative self-care is taught to patients in the orthopaedic department of a rehabilitation hospital after a minimally invasive hip arthroplasty and explored ways to optimise such teaching methods. Data were collected by conducting three focus groups with nine nursing professionals and expert interviews with the chief surgeon and the assigned physiotherapist. Data were analysed by using qualitative content analysis procedures. Results showed that teaching to enhance self-care competence of patients was not carried out systematically. Instead, the primary focus was to inform and prescribe rather than empower patients. Empowerment, however, would be necessary to assure adherence to the treatment regime. Hospital discharge often takes place surprisingly early and prevents assessment-based counselling of patients. The researchers concluded that the introduction of the minimally invasive surgical technique requires that the multidisciplinary rehabilitation team adapts its teaching methods. Self-care confidence in patients should be enhanced by following participatory clinical pathways. This demands modification in discharge and rehabilitation teaching plans to make them patient-oriented, and the plans should be supported by the entire team and the management.

Re: Five‐year results of surgical colorectal cancer treatment in rural Australia

ANZ Journal of SurgeryVolume 83, Issue 7-8 p. 592-592 LETTER TO THE EDITOR Re: Five-year results of surgical colorectal cancer treatment in rural Australia Cameron Platell MBBS, PhD, FRACS, Cameron Platell MBBS, PhD, FRACS Colorectal Surgical Unit, St John of God Hospital Subiaco Department of Surgery, The University of Western Australia, Perth, Western Australia, AustraliaSearch for more papers by this author Cameron Platell MBBS, PhD, FRACS, Cameron Platell MBBS, PhD, FRACS Colorectal Surgical Unit, St John of God Hospital Subiaco Department of Surgery, The University of Western Australia, Perth, Western Australia, AustraliaSearch for more papers by this author First published: 28 July 2013 https://doi.org/10.1111/ans.12287Citations: 1Read the full textAboutRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume83, Issue7-8July-August 2013Pages 592-592 RelatedInformation RecommendedFive-year results of surgical colorectal cancer treatment in rural AustraliaMatthias W. Wichmann, Eben Beukes, Shaukat T. Esufali, Lutz Plaumann, Guy Maddern, ANZ Journal of SurgeryShort‐term outcomes after surgical resection for colorectal cancer in South AustraliaKerri Beckmann MPH PhD, James Moore FRACS, David Wattchow FRACS PhD, Graeme Young FRACP MD, David Roder MPH DDSc, Journal of Evaluation in Clinical PracticeMen with colorectal cancer are predisposed to prostate cancerAndrew R. Moot, Adrian Polglase, Graham G. Giles, O. Margaret Garson, Vicky Thursfield, David Gunter, ANZ Journal of SurgeryEmergency treatment of complicated colorectal cancer in the elderly. Should the surgical procedure be influenced by the factor ‘age’?I. KESISOGLOU md, assistant professor of general surgery, I. PLIAKOS trainee in general surgery , K. SAPALIDIS md, chief surgeon of general surgery, N. DELIGIANNIDIS md, chief surgeon of general surgery, S. PAPAVRAMIDIS md, professor of general surgery, European Journal of Cancer CareClinical and pathological evaluation of patients with prostate and colorectal cancer five or more years after curative resectionJung Nam Lee, Yeon Ho Park, Jung Han, Jeong-Heum Baek, Sung Won Park, Won-Suk Lee, Surgical Practice

Influence of navigation system updates on total knee arthroplasty

BackgroundThe purpose of this study was to evaluate the influence of image-free computer-assisted navigation system update on outcome in total knee arthroplasty.MethodsThirty-three knees were replaced using the Stryker 3.1 image-free navigation system and 49 knees were replaced using the Stryker 4.0 system. One surgeon took part in all procedures as chief surgeon or first assistant. All patients received the Stryker Scopio NRG CR total knee prosthesis. We compared the accuracy of component positioning measured using radiographs and CT scans, operating time and clinical outcome 1 year after surgery.ResultsThe mean hip-knee-ankle, frontal femoral and tibial component angle were 179.8° (ideally implanted 85%), 89.8° (88%), 90.4° (88%) respectively for the 3.1 group and 179.5° (96%), 90.6° (92%), 90.2° (94%) for the 4.0 group. The mean sagittal tibial component angle was 85.5° (82%) for the 3.1 group and 85.6° (92%) for the 4.0 group. The mean rotational femoral and tibial component angle were −0.5° (81%), −0.7° (73%) for the 3.1 group and 0.0° (84%), 0.4° (72%) for the 4.0 group. There were no statistically significant findings with regard to component positioning.Operating time was significantly longer in the 3.1 group (3.1 group: 137 min, 4.1group: 125 min, P < 0.01).No significant difference was detected in postoperative clinical outcome.ConclusionThe navigation system update from Stryker 3.1 to Stryker 4.0 reduced operating time by 12 min. However, there were no statistically significant findings with regard to component positioning and clinical outcome.

Effect of Military Conflicts on the Formation of Emergency Medical Services Systems Worldwide

This article briefly reviews the evolution of medical support during wars and conflicts from ancient to modern times and discusses the effect warfare has had on the development of civilian health care and emergency medical services (EMS). Medical breakthroughs and discoveries made of necessity during military conflicts have developed into new paradigms of medical care, including novel programs of triage and health assessment, emergency battlefield treatment and stabilization, anesthesia, and other surgical and emergency procedures. The critical role of organizations that provide proper emergency care to help the sick and injured both on the battlefield and in the civilian world is also highlighted.

Imparting Surgical Training in Private Practice

Imparting Surgical Training in Private Practice