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Surgical Technology International I contains 66 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.

 

1991 - ISBN 1 85745 020 5

 

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Introduction by Ben Eiseman MD, FACS

Sections

Surgical Overview

 

The Current and Future Status of Lasers in Surgery
John C. Fisher ScD, Consultant in Laser Medicine and Surgery, Bradenton, Florida

01-029

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Abstract

Almost from the moment of its invention, the laser was destined to play a significant role in surgery. This intense new source of coherent, radiant energy inevitably attracted the attention of imaginative physicians and surgeons, who immediately recognised its potential for precise removal of diseased tissue.

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The Surgical Biology of Cancer
Victor Richards MD, FACS, Clinical Professor of Surgery, Stanford University School of Medicine and UCSF, Palo Alto, California

01-037

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Abstract

The surgical principles in the treatment of cancer were first clearly enunciated in 1906 by Halsted in the treatment of carcinoma of the breast, namely wide surgical removal of the breast together with the regional lymph nodes to which it spreads. The hope was that the regional nodes would serve as filters and prevent the spread of malignant cells into the blood stream, enabling the surgeon to excise every last cancer cell from the patient, thereby curing the cancer.

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The Impact of Biotechnology on Surgery in the 1990s
G. Kirk Raab, President, Genentech Inc., South San Francisco, California, Barry M. Sherman MD, Medical Director, Genentech Inc., South San Francisco, California

01-041

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Abstract

Medical practice is generally divided into medical and surgical sub-groups based on therapeutic approaches. Physicians in medically oriented specialities, such as internal medicine and paediatrics, traditionally rely largely on drugs to influence the course of disease while general and speciality surgeons usually have some type of surgical procedure at the core of their discipline. (Obviously, these are gross generalisations; surgeons have long been at the forefront of the use of antibiotics and nutritional support.) But these distinctions are becoming increasingly blurred as cardiologists guide catheters into ever smaller vessels and gastroenterologists send fibreoptic scopes into yet other ducts and snare would-be cancers from ever more remote parts of the gut. The recent explosion in scientific knowledge will continue to fuel this trend. Greater understanding of the fundamental mechanisms of disease inevitably leads to a simpler approach to diagnosis and therapy.

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Functional Organ Replacement, The New Technology of Tissue Engineering
C. A. Vacanti MD, Department of Anaesthesiology White 5, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, J. P. Vacanti MD, Department of Surgery, Children's Hospital and Harvard Medical School, Boston, Massachusetts

01-043

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Abstract

Functional failure of one vital organ results in death. The surgical implantation of tissue with the capacity to replace lost organ function, from one individual into another, is termed transplantation. In Boston, in 1954, Joseph E Murray performed the first successful human organ transplant, that of a kidney from an identical twin into his brother.

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Advances in Anaesthetic Monitoring for the 1990s
Martin J. London MD, Associate Professor, Chief of Anaesthesia, Denver Va Medical Center, University of Colorado Health Sciences Center, Denver, Colorado

01-51

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Abstract

Given the anaesthesiologists 'credo 'vigilance' it should come as no surprise that monitoring is accorded high priority in anaesthetic practice. Although the critical basics of monitoring have changed little since the earliest days of the specialty, namely visual observation (i.e. skin colour, rate and depth of respiration, position and location of patient and endotracheal tube etc.) and physical contact with the patient (i.e. finger on the pulse for heart rate and estimation of blood pressure, temperature, peripheral perfusion etc.) there is no question that technological advances have greatly enhanced these basic observations. The 1980s were especially pivotal. In this decade major advances have been made in respiratory and cardiovascular monitoring. Many of these advances have been credited with facilitating a major reduction in perioperative anaesthetic morbidity and mortality. For instance, with the routine use of pulse oximetry and capnography, the chance of an unrecognized esophageal intubation of sufficient duration to result in anoxic brain damage have been almost eliminated.

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Intrathecal lnfusional Therapies for Intractable Pain
Elliot S. Krames MD, Medical Director, San Francisco Center for Comprehensive Pain Management, San Francisco, California

01-059

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Abstract

There has recently been an increased interest in the safety, efficacy and relative ease in the delivery of intraspinal analgesics for the control of intractable pain. Recent technological advances have provided clinicians with precise and accurate delivery systems for long term infusion of spinally administered drugs. Because of these advances, there has been a rapidly growing interest in long term intraspinal infusional therapy for the control of chronic pain.

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Antibiotic Update for the Surgeon
Lowell S. Young MD, Director, Kuzell Institute for Arthritis and Infectious Diseases; Chief, Division of Infectious Disease, California Pacific Medical Center; Clinical Professor of Medicine, UCSF, San Francisco, California

01-067

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Abstract

The number of antimicrobial agents that have been introduced into clinical practice continues to increase. This development, however, is not unique to the antibiotic field. All one has to do is to look at the burgeoning number of compounds for antiinflammatory or cardiovascular indications to recognise that the pharmaceutical industry continues to provide us with new compounds of increased potency and broadened therapeutic applicability. On the other hand, not all new drug introductions represent clinical breakthroughs. Some agents can be, quite frankly, classified as 'me too' drugs. Nonetheless, even a fairly simple congener could be a welcome addition to the therapeutic armamentarian if it is safer, less toxic, cheaper, and more convenient to use than previously available therapy.

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Treatment of Infections Associated with Implanted Medical Devices
C. Chuard MD, Division of Infectious Diseases, Department of Medicine, F. A. Waldvogel MD, Chief, Dept. of Medicine, University Hospital, Geneva, and Professor of Medicine, University of Geneva Medical School, Geneva, Switzerland

01-073

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Abstract

The development of an infection in the vicinity of an implanted medical device is a dramatic event in many fields of surgery, especially cardiovascular, orthopedic and neurosurgery. The diagnosis of these infections is usually difficult and their treatment is always complex and represents a challenge for both surgeons and infectious diseases specialists. As foreign materials are used with increased frequency in modern medicine, this problem will probably remain a major one in the future despite the improvement of techniques and the use of new antibiotics. For patients, infection of a prosthetic device often means the loss of its function and. is sometimes associated with a high mortality.

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Uses of Ultrasound in a Surgical Practice
Gretchen A. W. Gooding MD, Professor and Vice Chairman, Department of Radiology, UCSF and Chief of Radiology, Veterans Administration Medical Center, San Francisco, California

01-083

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Abstract

The applications of sonography multiply year by year. The technology initially progressed from a simple A-mode signal, to contact scanners which produced B-mode images. These, in turn, were supplanted by real-time instruments capable of defining motion. The next development was the duplex Doppler machines which characterised flow from an image in a specific area. Now, colour coding of vascularity and high resolution imagery have become the standards of excellence.

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Hepatic Resection Using Ultrasonic Fragmentation
Kevin S. Hughes MD, Lahey Clinic Medical Center, Burlington, Massachusetts, Paul H. Sugarbaker MD, Lahey Clinic Medical Center, Burlington, Massachusetts

01-089

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Abstract

The frequency with which hepatic resection is undertaken has rapidly expanded. This is due to a better understanding of hepatic anatomy and physiology, and a better appreciation of the indications for resection. As a result of Foster's liver tumour survey of 1974, and Adson's early publications hepatic resection has become almost commonplace. However, though the mortality of the procedure has decreased to five to 10 per cent, the morbidity continues to range from 20 to 27 per cent, Ultrasonic dissection has the unique potential to decrease the morbidity and mortality of this procedure by minimizing blood loss and creating a controlled operative event.

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Blood Substitutes
Robert M. Winslow MD, Director of Research Laboratory, Letterman Army Institute of Research, Letterman Army Hospital, San Francisco, California

01-097

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Abstract

Although the need for an alternative to red cells for transfusion has been recognised since the initial description of the circulation of the blood by William Harvey in 1628, there is still no approved product available to clinicians. Recent concern over the safety of human blood has stimulated a renewed interest in finding alternatives to transfusion of red cells. Two types of solutions, those based on perfluorocarbons and those based on haemoglobin are currently being aggressively developed.

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Endoscopic Instrumentation and Equipment for Surgery
Anthony Nobles PhD, Nobles-Lai Engineering, Costa Mesa, California

01-102

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Abstract

The popularity of Endoscopy for both diagnostic and therapeutic procedures is a result of advanced development of new technologies, such as industrial video and fibre optics. Surgeons have 'new sets of eyes' and therefore it becomes necessary to familiarise ourselves with articulating instruments while looking at a television monitor not at the surgical sight. With the field of endoscopy evolving so quickly, it is imperative for the surgeon to adapt his or her technology to optimise patient gain and minimise procedure risk. If new technology is ignored, the.disservice is done both to the physician and the patient. 'If you do not become part of steam roller, you become part of the road.’

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Autotransfusion Cell-Saver and Plasma Saver
Roy L. Tawes Jr. MD, Peninsula Hospital Medical Center, Burlingame, California, Thomas B. DuVall BS, Peninsula Hospital Medical Center, Burlingame, California

01-110

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Abstract

Early attempts at blood salvage during surgery shared many of the complications associated with the development of cardiopulmonary (heart-lung) bypass machines; especially, coagulopathy and air embolism. By the late 1970s, the technology had developed to the point where not only were the red blood cells salvaged, but washed and processed in a manner that prevented auto-immunisation, transfusion reactions, and transmission of diseases. Blood conservation became practical.

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The Rapid Infusion System
Roy L. Tawes Jr. MD, Peninsula Hospital Medical Center, Burlingame, California, Thomas B. DuVall BS, Peninsula Hospital Medical Center, Burlingame, California

01-112

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Abstract

Haemorrhage often leads to shock with complications of acidosis, hypothermia and coagulopathy. Despite massive transfusions and supposedly adequate volume replacement, patients that are acidotic and hypothermic still develop clinically significant bleeding and clotting problems attended by a high mortality.

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Chronic Wounds Yesterday's Challenges Healing Today
John Crew MD, Medical Director, San Francisco Wound Care Center, Seton Medical Center, Daly City, California

01-114

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Abstract

Chronic, non-healing wounds have been a challenge to surgeons for years. Physicians get frustrated trying multiple modalities to heal the wounds with varying degrees of success. Patients and their families get impatient and depressed because the wounds will not heal. Hospitals in the US lose money on these patients because so many of them are in the Medicare population and require lengthy hospitalisations. Third party payors spend inordinate amounts of money on these patients since they require on-going care even though they are not healing. This scenario is a major challenge in health care today as we face caring for an aging population more prone to chronic wounds.

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Fixed Combination of Fibrin Glue with a Sheet of Collagen
A 'ready-to-use' local haemostyptic agent

Ulrich Schiele ScD, Hormon-Chemie Munchen GMBH/NYCOMED Arzneimittel GMBH, Munchen, Germany, Günter Kuntz MD, ScD
Hormon-Chemie Munchen GMBH/NYCOMED Arzneimittel GMBH, Munchen, Germany, Anita Riegler, Hormon-Chemie Munchen GMBH/NYCOMED Arzneimittel GMBH, Munchen, Germany

01-120

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Abstract

There are still situations in surgery when diffuse bleeding becomes a severe problem. This may occur especially during operations involving parenchymal tissue and, or in cases of impaired haemostasis. Several methods are available to control diffuse bleeding, and in addition to classical methods like sutures or tamponade, there are essentially two approaches:
•Application of physical methods (e.g. electro-coagulation and infra-red-coagulation)
•Application of local haemostyptic materials.

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Haemostasis by Computerised Bipolar Diathermy
Bertil Vällfors MD PhD, Department of Neurosurgery, Sahlgrenska Hospital, University of Göteborg, Göteborg, Sweden, Björn Bergdahl MSc, Department of Neurosurgery, Sahlgrenska Hospital, University of Göteborg, Göteborg, Sweden

01-127

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Abstract

Modern bipolar diathermy has certain limitations, especially regarding the regulation of the short coagulation course: it is somewhat awkward to use, is prone to mechanical malfunction and time consuming. The computerised bipolar diathermy system was originally developed for solving these problems in neurosurgery. It has now gained wide acceptance by all the surgical sub-specialities. Electronic feedback of the tissue impedance automatically starts and shuts off coagulation when a blood vessel is picked up by the forceps. The shut-off is related to a point in the impedance course that correlates to a temperature of 60 to 90°C, i.e. after coagulation has occurred and before complete desiccation, fulguration and sticking of the forceps has taken place.

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