Surgery In America Research Articles

How did COVID-19 influence use of neoadjuvant therapy before surgery for patients with HPB cancers?

Background: The COVID-19 pandemic caused widespread disruption of the United States (US) healthcare system. Medical resources were rationed, and healthcare organizations worked to prevent hospitalizations in both healthy and high-risk patients. Numerous surgical specialties decreased elective operations during the peak of the pandemic, but surgical oncologists were faced with balancing the risks of oncologic progression with exposing immunosuppressed patients to nosocomial COVID-19. In recent years neoadjuvant therapy (NAT) has been increasingly utilized in pancreatic and colorectal malignancies. However, no analyses have determined whether these practice patterns were disrupted by the pandemic. Thus, the aims of this study were to evaluate the effect of COVID-19 on the volume of operations for pancreatic, primary hepatic, and secondary hepatic malignancies in patients who had undergone NAT. Methods: The Vizient Clinical Database was queried for national data from participating hospitals, including 97% of academic medical centers and over 100 oncologic hospitals. These institutions perform the majority of pancreatic and hepatic surgery in America. Data were obtained for 12 months before (March 2019 – February 2020) and 27 months during (April 2020 – June 2022) the COVID-19 pandemic. Patients who underwent neoadjuvant therapy (chemotherapy or immunotherapy) followed by major operations for pancreatic, primary hepatic (hepatocellular carcinoma and intrahepatic cholangiocarcinoma), and secondary hepatic (colorectal metastases) malignancies were included. Case volume trends were compared before and during the pandemic using QI Macros Control Charts. Mean comparison of case volume before and during the pandemic was performed using Student’s t Test and Wilcoxon Rank Sum Test in R (Version 4.2.1). Results: Over the 40-month study period, 6,936 patients received NAT and underwent surgery; 5,594 patients (80.7%) had pancreatic operations, 685 patients (9.9%) underwent surgery for primary hepatic malignancies, and 657 patients (9.5%) had hepatic operations for metastatic colorectal cancer. Pancreatic operations for patients who received NAT steadily increased throughout the study period (Figure A) while hepatic operations for metastatic colorectal cancer after NAT (Figure C) transiently increased 20 months into the pandemic. Operations for primary hepatic malignancies in patients who received NAT were unaffected by the pandemic (Figure B). These findings were confirmed with the average monthly case volume for pancreatic operations increasing during COVID-19 (126 vs 146, p< 0.001). No statistically significant changes were noted in the mean monthly operative volume for primary hepatic malignancies (17 vs 17, p=0.809) or for secondary hepatic malignancies following NAT (15 vs 17, p=0.213). Conclusion: Despite the pandemic, the number of oncologic operations for pancreatic cancer following neoadjuvant therapy (NAT) increased over time, continuing a pre-pandemic trend. A transient increase in oncologic operations for secondary hepatic malignancies following NAT was observed late in the pandemic. The volume of operations following NAT for primary hepatic malignancies was unaffected by the pandemic. The utilization of NAT for operative hepato-pancreato-biliary malignancies was not altered by the COVID-19 pandemic.

Did COVID-19 disrupt surgery for patients with pancreatic and hepatic malignancies?

Background: The COVID-19 pandemic began to affect the United States (US) healthcare system in March 2020. By April 2020, multiple government and professional organizations published guidelines to restrict elective operations in an effort to conserve hospital resources. However, the risk of progression made procedures for malignancy more time sensitive than other elective operations. As a result, patients with pancreatic and hepatic malignancies who required surgery were prioritized. However, after two and a half years of the COVID-19 pandemic, only sparse data exist on how the contagion affected the volume of cancer operations in the US. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the national monthly volume of pancreatic and hepatic operations for malignancy. Methods: The Vizient Clinical Database was queried for national data from participating hospitals, which includes 97% of academic medical centers and over 100 oncologic hospitals. These institutions perform the majority of pancreatic and hepatic surgery in America. Data were gathered for 12 months before (March 2019 – February 2020) and 27 months during (April 2020 – June 2022) the COVID-19 pandemic. Patients undergoing major operations for pancreatic, primary hepatic (hepatocellular carcinoma and intrahepatic cholangiocarcinoma), and secondary hepatic (colorectal metastases) malignancies were included. Case volume trends were compared before and during the pandemic using QI Macros Control Charts. Comparison of mean case volume before and during the pandemic was performed using Student’s t Test and Wilcoxon Rank Sum Test in R (Version 4.2.1). Results: A total of 26,662 patients underwent surgery over the 40-month study period for pancreatic (Nf17,724, 66.5%), primary hepatic (Nf7,100, 26.6%), and secondary hepatic (Nf1,838, 6.9%) malignancies. Operations for pancreatic cancer (Figure A) and colorectal liver metastases (Figure C) were unaffected by the pandemic. Operative volumes for primary hepatic malignancies (Figure B) transiently decreased at the beginning of the pandemic, but returned to the pre-pandemic baseline within five months. No statistically significant changes were observed in the mean monthly operative volume before and during the pandemic for pancreatic (433 vs 447, p=0.208), primary hepatic (183 vs 175, p=0.224), or secondary hepatic (44 vs 47, p=0.397) malignancies. Conclusion: The COVID-19 pandemic did not significantly disrupt the volume of operations for pancreatic or secondary hepatic malignancies in the United States. The pandemic transiently decreased the rate of hepatic operations for primary liver tumors, but this rate returned to the pre-pandemic baseline within five months. Surgery for pancreatic and hepatobiliary malignancies was prioritized during the pandemic.

The introduction of wide-angle 270° laparoscopy through a novel laparoscopic camera system

Laparoscopy has enjoyed improvements over the last three decades primarily in achieving high definition, but the 70° field of view (FOV) remains unchanged. Complications related to events that take place out of the FOV continue to be reported. Additional problems leading to poor visualization are fogging and smoke accumulation. A novel laparoscopic system (SurroundScope, 270Surgical) was developed and dramatically expands the FOV from the 70° to 270° by adding side cameras at the distal tip of the laparoscope, while LED illumination eliminates fogging and improves smoke effects. This study describes the initial clinical experience with SurroundScope and its potential advantages over traditional laparoscopy. SurroundScope was studied at Bnai Zion Medical Center in Israel and the Minnesota Institute for Minimally Invasive Surgery in America. 27 laparoscopic surgeries were performed, and at the end of each procedure, evaluations were completed by all surgeons and camera holders. All 27 cases were completed successfully without adverse events. No injuries occurred as a result of surgical tool manipulation outside of the central frame while 133 potentially adverse events were identified on side frames. There was no fogging across the 27 cases. The impact of smoke was negligible in all cases, as laparoscope removal or venting was never necessary. Surgeon respondents indicated that tools could be followed from the port to the site of surgery without camera manipulation. Most surgeons strongly agreed that the potential to identify bleeding was improved. Camera holders strongly agreed that the ergonomics were improved and that they moved the camera less than with a standard laparoscope. Initial results demonstrate numerous advantages for SurroundScope as compared to traditional laparoscopy. The important benefits of expanded FOV, complete lack of fogging, and negligible smoke may improve patient safety, reduce adverse events and the duration of surgery. Further investigation to quantify these benefits is recommended.

Historical Development of Modern Surgery in America

Surgeons use operative procedure to save life and to treat patient’s disease. Advances are made with new operations and/or designing and modification of surgical instrument. This paper reviews the great surgical advances in the United States in the last century, presented in tabular form and arranged chronologically by year of first publication. Major topics covered include: cancer management, pulmonary, cardiac and vascular surgery, war surgery, care of trauma and burn, minimal invasive and robot surgery, organ transplantation and facial reconstruction, medical and surgical devices.

Issues that face rural surgery in the United States.

The social and economic issues that encumber rural communities in the United States threaten surgical practices that serve them. The term rural surgery refers to the practice of surgery serving people in rural communities and geographically remote areas. The myriad issues fall into 3 broad areas that parallel the tectonic pressures on rural America and medical economics: the demographic and economic decline of rural communities; a change in surgery in America brought on by the workforce shortage in general surgery; and a shift in the structure of surgical practice from an independent practitioner single hospital relationship to an employed corporate model. Each challenges relationships among the hospital, surgeon, and the community. Solutions lie in not considering each group in isolation, but considering the triad as a whole. A central task is to improve the quality of surgical care in rural America, a measure that will both drive caseloads to rural surgeons and hospitals and improve the care they provide to their communities.

Gifted hands

Gifted hands

The Department of Surgery at NewYork–Presbyterian Hospital/Weill Cornell Medical Center: At the Forefront of Surgical Innovation

T HE HISTORY OF surgery at The New York Hospital, the second oldest hospital in the United States, reflects the evolution of surgery in America and is marked by some of the most extraordinary achievements in medicine. The New York Hospital was the cradle of early surgical developments and instruction in America, earning a worldwide reputation for excellence and innovation. With the affiliation agreement between New York Hospital and Cornell University almost 100 years ago, the Department of Surgery developed into an academic unit that contributed clinical care and education to countless patients, students, and residents and generated innovations for the benefit of the surgical patient. With the more recent merger of New York Hospital and Presbyterian Hospital into a new entity, NewYork–Presbyterian Hospital, our Department is poised to continue making additional important contributions to the advancement of the art and science of surgery by building on our rich legacy of surgical care, teaching, and innovations.

Lewis A. Sayre: The First Professor of Orthopaedic Surgery in America

Lewis Albert Sayre (1820-1900) is considered to be among the founding fathers of orthopaedic surgery in the United States. He studied medicine at the College of Physicians and Surgeons (now of Columbia University). Sayre later helped establish the first academic department of orthopaedics at the Bellevue Medical College where he served as their first Professor of Orthopaedics. Lewis Sayre treated a considerable diversity of musculoskeletal conditions and meticulously documented them with written notes, sketches, and photographs. As a public figure, his methods were controversial, attracting praise by some and inviting criticism by other prominent members of the international community. He made great strides for physicians, helping to charter the American Medical Association and to establish the weekly publication of the Journal of the American Medical Association.

Thinking inside the graft: applications of optical coherence tomography in coronary artery bypass grafting

Recent advances in catheter-based optical coherence tomography (OCT) have provided the necessary resolution and acquisition speed for high-quality intravascular imaging. Complications associated with clearing blood from the vessel of a living patient have prevented its wider acceptance. We identify a surgical application that takes advantage of the vascular imaging powers of OCT but that circumvents the difficulties. Coronary artery bypass grafting (CABG) is the most commonly performed major surgery in America. A critical determinant of its outcome has been postulated to be injury to the conduit vessel incurred during the harvesting procedure or pathology preexistent in the harvested vessel. As a test of feasibility, intravascular OCT imaging is obtained from the radial arteries (RAs) and/or saphenous veins (SVs) of 35 patients scheduled for CABG. Pathologies detected by OCT are compared to registered histological sections obtained from discarded segments of each graft. OCT reliably detects atherosclerotic lesions in the RAs and discerns plaque morphology as fibrous, fibrocalcific, or fibroatheromatous. OCT is also used to assess intimal trauma and residual thrombi related to endoscopic harvest and the quality of the distal anastomosis. We demonstrate the feasibility of OCT imaging as an intraoperative tool to select conduit vessels for CABG.

The Forgotten Hysterectomy

The history of gynecology and surgery in America has been well documented. However, a landmark operation took place in 1856 that has gone unrecognized in modern surgical texts. William J. Baker and associates performed the first successful abdominal hysterectomy with bilateral salpingo-oophorectomy in Knoxville, Tennessee on November 13, 1856. The patient recovered uneventfully and lived for 34 years after her procedure. This case has yet to be noted in modern medical history texts. It is important that the accomplishments of Dr. Baker and his associates be recognized among the surgical pioneers of their day.

Long-term evaluation of Carpentier-Edwards porcine bioprosthesis for rheumatic heart disease

Objectives The clinical results of Carpentier-Edwards standard bioprosthesis have been extensively studied for valvular heart surgery in America and Europe. However, the data of long-term performance of Carpentier-Edwards standard porcine valve in areas with a high prevalence of rheumatic heart disease are still lacking. In this study, we assessed the clinical performance of Carpentier-Edwards standard porcine bioprostheses in a patient group with high prevalence of rheumatic heart disease. Methods A total of 872 patients underwent valvular heart surgery with Carpentier-Edwards standard porcine bioprostheses replacement between 1975 and 1999 and the results were analyzed. Rheumatic etiology counts for 95% of the patients. Mean age of operation was 40 ± 14 years (mitral valve), 43 ± 19 years (aortic valve), and 45 ± 13 years (double valve). Follow-up was 95.6% complete and continued up to 24 years (total 7017 patient-years) with mean of 8.9 ± 5.1 years. Results The operative mortality rate was 5.85%. Actuarial patient survival rates after discharge at 5, 10, 15, and 20 years were 92.5%, 83.8%, 72.3%, and 35.8%, respectively. A total of 442 cases received reoperation due to failure of bioprostheses. The mean duration to valve failure is 12.2 ± 0.4 years. Actuarial estimate of freedom from structural valvular failure at 5, 10, 15, and 20 years were 96.3%, 63.7%, 24.4%, and 7.7%, respectively. Conclusion The long-term result of Carpentier-Edwards standard bioprostheses in the present patient group is satisfactory. However, freedom from valve failure is lower than that of Western series. Younger age at operation and higher prevalence of rheumatic etiology in this area are possible causes.

Ambulatory anesthesiaand surgery in America: A historical background and recent innovations

This article describes the history of ambulatory surgery and anesthesia in the United States. The innovations in surgical instrumentation and techniques, newer anesthesia drugs and techniques, as well as insurance provider changes that have led to an increase in the numbers and types of surgeries performed in outpatient settings in the United States, are detailed.

A Portrait of Surgery: Surgery in America, 1875–1889

Between the years 1875 and 1889, extraordinary changes occurred in the practice of medicine and surgery. This article reviews these changes and attempts to understand something of the science of surgery as well as its place in American medicine during these years. The essay uses the two paintings by Thomas Eakins, The Gross Clinic of 1875 and The Agnew Clinic of 1889, as endpoints to the period of discussion.

Surgery in America

Surgery in America

Surgery in America: From the Colonial Era to the Twentieth Century

Medical histories tend to follow several formats. They are either biographical catalogues, historical narratives, or a loosely connected collection of essays or memoirs. Dr Earle has styled his anthology differently, presenting the story of American surgery, the words of those who practiced in the past and knew the surgery of their times. This second, expanded edition of his book includes, selections from texts, lectures, or articles shaped the practice and philosophy of American surgery. Items were chosen that give a feeling both for surgery as it was practiced and for the time in which the piece was written. Each selection is prefaced by a biographical sketch. Sixty illustrations, including many portraits of the surgeon authors, complement the text, and exacting notes are provided for each chapter. The book begins with the first published description of a surgical procedure performed in an American colony (around 1640), Abigail Eliot's Head

A Clockwork Orange in a California Prison

A Clockwork Orange in a California Prison

Surgery in America, Selected Writings, by A. Scott Earle, Philadelphia and London, Saunders, 1965, pp. 280, illus., 59s. 6d.

Surgery in America, Selected Writings, by A. Scott Earle, Philadelphia and London, Saunders, 1965, pp. 280, illus., 59<i>s</i>. 6<i>d</i>.

Surgery in America

Surgery in America

Surgery in America. Edited by A. Scott Earle, M.D., Idaho. 9¾ × 6¼ in. Pp. 280 + x, with 44 illustrations. 1965. Philadelphia and London: W. B. Saunders Company. 59s. 6d

Surgery in America. Edited by A. Scott Earle, M.D., Idaho. 9¾ × 6¼ in. Pp. 280 + x, with 44 illustrations. 1965. Philadelphia and London: W. B. Saunders Company. 59s. 6d

Surgery in America

Surgery in America