Abstract:

Endoscopic surgery has led to changes in surgical practice which may rival the introduction of anesthesia and antibiotics in significance. As a result, an exciting synergy has rapidly emerged between technology and clinical practice. However, questions of training, credentialing, and patient safety have been raised as traditional procedures have been adapted to the minimally invasive approach and new ones are described. Many surgeons have been reluctant to venture beyond laparoscopic cholecystectomy. Halting first efforts at advanced procedures may prolong operative times, increase risk, and raise costs. Older methods of surgical education are not adequate to meet the current need

Authors:

Peter M. N. Y. H. Go, M.D., Ph.D., St. Antonius Hospital, Nieuwegein, The Netherlands; John H. Payne, Jr., M.D., F.A.C.S., Kaiser Foundation Hospital, Honolulu, HI; COL. Richard M. Satava, M.D., F.A.C.S., Walter Reed Army Medical Center, Alexandria, VA; James C. Rosser, M.D., F.A.C.S., Yale University, New Haven, CT

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Abstract:

For many years, the development and use of commercial information systems (IS) in medical environments have focused upon meeting the financial and administrative needs of medical care. Clinical information systems developed along a relatively separate path, primarily in academic and medical center environments. Today, trends resident throughout the United States are forcing the clinical, financial, and administrative sides of medicine to come together. These coalescing forces are driving the development of a new generation of information systems, with direct use and application for clinical practitioners.

Authors:

Joseph M. DeLuca, M.B.A., Rebecca Enmark Cagan, M.L.I.S., JDA, San Francisco, CA

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Abstract:

The concept of a machine-augmented surgeon will become a widespread reality only after the barrier of harnessing the “computer as a tool” has been successfully accomplished. The prospects of surgical robots for computer-assisted surgery, for telemedicine, and for teleoperation–cybersurgery–will be greatly enhanced when computers are no longer considered a separate component that links a system together; they must lose their identity, becoming “transparent.” The ideal human-machine interface for surgery is one juxtaposed between surgeon and patient that derives digital biosignals directly from both bodies, transmitting them transparently without perceptible delay, and distributes them bilaterally into afferent (sensory) and efferent (operator or effector) limbs.1 This ideal human-computer interface will be based upon biosignal processing and will “optimize the technology to the physiology,” in what has been called “biocybernetics.”2 Applications of biosignal interfaces are being developed in entertainment, medicine, commerce, defense, and in sales and distribution

Authors:

Wm. LeRoy Heinrichs, M.D., Ph.D., F.A.C.O.G., Stanford Endoscopy Center for Training and Technology, Stanford University School of Medicine, Stanford, CA; Anthony Lloyd, BioControl Systems, Inc., Palo Alto, CA

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Abstract:

The clutter of equipment and lines in today’s operating room (OR) is increasing. This problem may present unnecessary hazards to traffic and adversely affect the performance of the surgical team. Endoscopic surgery is particularly affected by this problem because it requires additional equipment. This study offers surgeons’ views about OR crowding and provides a detailed summary of the distribution of furniture, equipment, cables, and tubes during open and laparoscopic operations. We prospectively studied an unselected series of general surgical open (OP, n=10) and laparoscopic (LAP, n=10) operations performed at a major university teaching hospital.

Authors:

Ramon Berguer, M.D., University of California, Davis, CA, VA Northern California Health Care System, Martinez, CA; Angel Alarcon, M.D., Central University of Ecuador, Quito, Ecuador

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Abstract:

The explosive development of minimally invasive surgery has had a staggering impact on the hospital, operating room, and surgeon, as well as on the medical equipment industry and insurance carriers.1 As a result of (1) the overwhelming demand by the public, (2) the potential of future developments of this modality, and (3) the progressive geometric influence that has spread to the various surgical subspecialties, unprecedented pressure has been placed on our systems for training, credentialing, developing, supplying, and evaluating changes in surgical technique.

Authors:

Zoltan Szabo, Ph.D., F.I.C.S., M.O.E.T. Institute, San Francisco, Ca; E. Daniel Biggerstaff III, M.D., F.A.C.O.G., Advanced Surgery Center, Candler Hospital, Savannah, GA; Norma Jean Kelly, B.S.N., M.H.S., Center for Advanced Training & Research, Candler Hospital, Savannah, GA; Wanda Toy, M.T.(A.S.C.P.), M.O.E.T. Institute, San Francisco, CA

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Abstract:

"Man is the only animal capable of tying a square knot. During the course of an operation you may be asked by the surgeon to tie a knot. As drawing and coloring are the language of art, incising, suturing and knot tying are the grammar of surgery. A facility in knot tying is gained only by tying ten thousand of them. When the operation is completed, take home with you a package of leftover sutures. Light a fire in the fireplace and sit with your lover on a rug in front of the fire. Invite her to hold up her index finger, gently crooked in a gesture of beckoning. Using her finger as a strut, tie one of the threads about it in a square knot. Do this one hundred times. Now make a hundred grannies. Only then may you permit yourself to make love to her. This method of learning will not only enable you to master the art of knot tying, both grannies and square, it will bind you, however insecurely, to the one you love.”

Authors:

Thomas A. Stellato, M.D., F.A.C.S., Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH; Ashwani Rajput, M.D., Case Western Reserve University, Cleveland, OH

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Abstract:

From earliest times, visual aids–from crude diagrams to complex, beautiful wax anatomical models1–have been created to enhance the surgical learning process. Surgical educators realized early that suitable models could be used to develop the needed technical expertise essential to the safe performance of surgery. Practice on models also assisted in developing surgical judgment.

Authors:

Stephen J. Shapiro, M.D., F.A.C.S., UCLA Medical Center, Endocare, Los Angeles, CA; Margaret Paz-Partlow, M.F.A., Midway Hospital Medical Center, Los Angeles, CA; Leon Daykhovsky, M.D., Cedars-Sinai Medical Center, Los Angeles, CA; Leo A. Gordon, M.D., F.A.C.S., Cedars-Sinai Medical Center, Endocare, Los Angeles, CA

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Abstract:

The rapidly expanding field of laparoscopic surgery has required surgeons to adapt to a new operating environment. New procedures and techniques test the surgeon’s skill and confidence. Supporting laparoscopic advances has required redesign of equipment and training. The latter often is presented in a step-by-step format related to a particular surgical procedure (e.g., laparoscopic cholecystectomy, laparoscopically assisted vaginal hysterectomy, etc.). The problems with this approach are the assumptions that the surgeon already possesses the necessary skills to perform fundamental surgical techniques in the new modality and that most participants enrolled in any given course will have a similar level of skill.

Authors:

James E. Lewis, M.D., F.A.C.O.G., Kaiser Permanente Medical Center, San Francisco, CA; Zoltan Szabo, Ph.D., F.I.C.S., M.O.E.T. Institute, San Francisco, CA

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Abstract:

Medicine is ever changing, as is the discipline of surgery. During the last decade, surgery has experienced a technological renaissance driven primarily by the desire to provide patients less invasive surgical treatments with shorter operating times, hospital stays, and recuperative periods. Many traditional open surgical procedures are now being replaced with endoscopic and laparoscopic techniques. 1,2 As these minimally invasive techniques become sublimated in medical practice, the quest to develop truly noninvasive techniques continues in many medical specialties.

Authors:

John B. Adams II, M.D., Medical College of Georgia, Augusta, GA; Robert G. Moore, M.D., Brady Urological Institute, Johns Hopkins Bayview Medical Center, Baltimore, MD; Kenneth W. Marich, M.S., M.B.A., Auburn University, Auburn, AL

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Abstract:

Technological advances in monitoring for anesthesia continue to provide clinicians with an increasing amount of physiologic information for critical intraoperative decision making. This expanded set of physiologic data not only makes “routine” surgery safer from rare, but potentially fatal, anesthetic or surgical mishaps; it also facilitates surgery on very high risk patients. However, it must be emphasized at the onset that “anesthesia monitoring” is probably more appropriately termed “perioperative” or “critical care” monitoring, since many of these advances are applicable in the critical care units as well.

Authors:

Martin J. London, M.D., University of Colorado Health Sciences Center, Veterans Affairs Medical Center, Denver, CO

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