Abstract:

The use of computerized robo tics in endoscopic surgery has prompted one to question whether this is the fifth and final step in surgical development. The progress of surgery through the centuries can be described as the eras of anatomy and physiology, anesthesia, antibiotics and minimally invasive surgery. The current situation is of more procedures being performed endoscopically not only in gynecology, but now also being embraced by other disciplines of human surgery.

Authors:

Duncan Turner, M.D., M.B., B.S., F.A.C.O.G. - Santa Barbara Cottage Hospital/De la Vina Surgicenter, Santa Barbara, CA; Kurt Semm, M.D., F.R.C.O.G., F.I.C.S. - University of Kiel, Grunwald, Germany

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Abstract:

Pancreatic surgery is generally accompanied by a high complication rate. Due to the specific properties of pancreatic tissue, sutures of the parenchyma lead to ischemic necroses, which in turn become foci of inflammation resulting in typical local complications such as postoperative hemorrhage, persistent pancreatitis, and pancreatic fistulae. The complication rate is high even after so-called minor interventions (Table 1).

Authors:

A.P. Marczell, M.D., Ph.D. - Hanusch Medical Center, Vienna, Austria

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Abstract:

Reducing the loss of energy by a patient during laparoscopic surgery supports better quality of life. Homo sapiens are homeothermic and are thus only able to effectively tolerate temperature changes ranging from 37+/ -O.5°C. Maintenance of body temperature both intra- and post-operatively is essential. Variations in temperature may bring about changes in enzyme reactions and metabolic processes in the body. Maintenance of body temperature in the central core, including the brain, thoracic and abdominal organs, is most vital.

Authors:

Kurt Semm, M.D., F.R.C.O.G., F.I. C.S.; Isolde Semm, M.D. - University of Kiel, Grunwald, Germany

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Abstract:

At one time, the US Government's health technology assessment programs [i,e., the evaluation of drugs, devices, and procedures used in health care for their safety, effectiveness, cost, and social implications) were models for both the public and private sector agencies and for the rest of the world. This time is no more. Three years has passed since the most prominent technology assessment program in this country, if not the world, was terminated by the US Congress.

Authors:

Dennis J. Cotter, M.S.E.; Seymour Perry, M.D., M.A.C.P.; Mae Thamer, Ph.D. - Medical Technology and Practice Patterns Institute, Washington, DC

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Abstract:

In the last 10 years there has been an increased awareness of the need for improved pain management, especially in the postoperative period, to a large extent stimulated by the US Agency for Health Care Policy and Research (AHCPR), which published its clinical practice guidelineS for pain management in 1992. Teams of surgeons, nurses and anesthesiologists now are combining modalities for managing pain so as to provide the most comfortable postoperative course possible for their patients.

Authors:

Paul H. Gerst, M.D., F.A.C.S.; Hanasoge T. Girishkumar, M.D., F.A.C.S.; Ajay Shah, M.D., F.A.C.S.; B. Narayan Pai, M.D., F.A.C.S.; Eugene Albu, M.D., F.A.C.S.; Vellor S. Parithivel, M.D., F.A.C.S. - Bronx - Lebanon Hospital Center, Bronx, NY

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Abstract:

The problem of resistance of microorganisms to antibiotics is not new, but in the past few years the development of resistance in common pathogens has heightened awareness and coverage in the lay press, as well as influential general scientific and medical journals. This has alerted public attention to the problem.

Authors:

Robert S. Baltimore, M.D., F.A.A.P. - Yale School of Medicine, New Haven, CT

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Abstract:

Rapid advancements in technology have dramatically changed the way our daily activities are conducted. In the practice of medicine and surgery, technological advances over the past few decades have had an enormous impact on the diagnosis and treatment of disease. In contrast, our methods of teaching surgeons to perform operations remain mired in the 100 year old Halstedian apprenticeship model. In this system, surgeons often learn to operate based on the principle of "see one, do one, teach one." Educational opportunities are largely dependent on chance as a patient with a particular disease pattern must present to the surgeon in order to achieve specific educational goals. Live patients are often used as the initial "practice session" for the learning surgeon in this model of education.

Authors:

Randy S. Haluck, M.D. - Penn State Geisinger Health System, Hershey, PA; Thomas M. Krummel, M.D., F.A.C.S. - Stanford University, Palo Alto, CA

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Abstract:

Glove powders are used by manufacturers of latex and synthetic surgical gloves to assist with the stripping of gloves from their molds, facilitate donning, and absorb moisture during use. Corn starch powders have replaced the originally used tale powder because of the induction of patient complications with the older preparations, However, recent research indicates that patient exposure to starch based powders during surgery may also cause problems. The frequency, variety, and severity of complications suggest that powder free alternatives be considered in the perioperative environment.

Authors:

Wava Truscott, Ph.D. - Safeskin Corporation, San Diego, CA

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