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SURGICAL TECHNOLOGY INTERNATIONAL IV.
$175.00
STI IV contains 65 articles with color illustrations.
Universal Medical Press, Inc.
San Francisco, 1995, ISBN: 0-9643425-2-9
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Surgical Overview
Teleconferencing Bridges Two Oceans and Shrinks the Surgical World
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
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 (Fig. 1).
Information Systems in the Perioperative Environment
Joseph M. DeLuca, M.B.A., Rebecca Enmark Cagan, M.L.I.S., JDA, San Francisco, CA
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.
The Essential Human-Machine Interface for Surgery: Biological Signals Transmission
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
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 (Table 1).
The Effects of Laparoscopic Surgery on the Operating Room Environment
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
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.
Designing an Advanced Laparoscopic Surgery Training Center
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
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.2
The Training of Surgical Residents in Laparoscopy
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
“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.”1
The Use of Models in Laparoscopic Education
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
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.
Formal Laparoscopic Skills Training: Evaluation by Surgical Specialists in a Health Maintenance Organization
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
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.
Focused Ultrasound: The Future of Noninvasive Surgery
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
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.
Advances in Anesthesia Monitoring
Martin J. London, M.D., University of Colorado Health Sciences Center, Veterans Affairs Medical Center, Denver, CO
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.
Cryosurgical Ablation of Hepatic Neoplasms
Marie J. Gorski, M.D., Daniel J. Deziel, M.D., F.A.C.S., Edgar D. Staren, M.D., Ph.D., F.A.C.S., Rush Medical College, Chicago, IL
Cryosurgical ablation involves the in situ freezing and resultant devitalization of neoplastic lesions. It offers a number of potential advantages over surgical resection that make it particularly appealing for the treatment of hepatic neoplasms. Recent improvements in imaging modalities used to monitor cryosurgery, particularly ultrasonography, have made it a reasonable procedure in select patients. Colorectal carcinoma accounts for the second highest cancer-related mortality in the United States with nearly 70,000 annual deaths from this disease.1 Approximately 150,000 new cases are diagnosed each year. The liver represents the sole site of metastatic spread in approximately 20% of cases, reflective of the preferential spread of colorectal cancer to the liver via the portal venous system.2 Unfortunately, fewer than 25% of these patients (i.e., 4000 to 5000 patients) are candidates for surgical resection secondary to bilobar involvement, proximity to major vessels, poor liver reserve, or co-morbid disease states. Currently, systemic chemotherapy offers no significant impact on survival in patients with colorectal liver metastases with response rates in the range of 20% to 30%.3
Encapsulated Islet Cell Therapy for the Treatment of Diabetes: Intraperitoneal Injection of Islets
Patrick Soon-Shiong, M.D., M.Sc., F.A.C.S.(C.), St. Vincent Medical Center, Los Angeles, CA VivoRx Inc., Santa Monica, CA; Paul A. Sandford, Ph.D., VivoRx, Inc., Santa Monica, CA
Since conventional insulin therapy has failed to achieve tight glucose control, an alternative treatment is urgently needed to treat diabetes. The findings of the Diabetes Control and Complication Trial1 conclusively establish that improved glycemic control delays the onset and slows the progression of neuropathy, nephropathy, and retinopathy in insulin-dependent diabetic patients. The disease leads inexorably to one or more of the secondary complications, including renal failure, blindness, coronary and peripheral vascular occlusive disease. The challenge physicians face is to intervene before these secondary complications take their toll. Transplantation of encapsulated human islets to reverse diabetes by a minimally invasive or minor surgical procedure, without the risk of high-dose or life-long immunosuppression will be described here. In the near future, the shortage of donor human tissue will be overcome either by the use of encapsulated xenograft (porcine) islets or proliferated human islets. Thus, encapsulated islet therapy may become possible for the millions of diabetic patients who may benefit from islet cell transplantation.