Abstract

Traumatic and end-stage organ loss or tissue damage remains a devastating issue for everyone, and a major problem for millions of patients. It has been estimated that each year in the United States more than 8 million surgical operations are performed to solve these health problems.

Abstract

President Clinton's Advisory Commission report on Consumer Protection & Quality in the Health-Care Industry, identified medical error prevention as an important issue in health-management. Patient safety is finally being institutionalized due to growing concern over the increasing cost of human error. Medicine's punitive perfectibility model in dealing with unintended injury is slowly evolving to accept error during operations as an inevitable, yet manageable, reality of surgery.

Abstract

A telerobotic device, the daVinci Surgical System (Intuitive Surgical, Inc., Mountain View, CA) is one of the recently developed, remotely operated systems for laparoscopic surgical procedures. This telemanipulation system consists of two components: a control console operated by the surgeon, and the surgical arm cart that holds a three-dimensional (3-D) 30° laparoscope and two detachable laparoscopic surgical tools. The instruments are equipped with a wrist - a unique feature that provides additional dexterity, Since its clinical introduction in Europe in early 1999, this system has opened up a new era in minimally invasive surgery enhancing endoscopic vision and anastomosis suturing. For the first time, cardiac surgeons were able to perform a totally endoscopic coronary bypass procedure on a beating heart.

Abstract

Local hemostasis is critical for successful surgical intervention and maybe accomplished with a variety of techniques rang ng from direct pressure to lasers. Critical assessment of the clinical situation is required to determine the appropriate technology necessary to achieve effective hemostasis. As a general rule, ligatures remain the mainstay for effecting hemostasis in all but the smallest isolated vessels. Although ligatures have been in use since the first century AD, both the applications as well as their sophistication have increased dramatically. As sutures are foreign material to the human body, tissue reaction is unavoidable. This response may be mitigated, but not eliminated completely, through the use of non-absorbable sutures. The body's inflammatory response triggers a complex cascade of cellular and biochemical events that lead to fibrinogenesis and coagulation. This process, in turn, results in an increased deposition of collagen that may result in formation of adhesions.

Abstract

Pancreaticoduodenectomy, mostly performed for pancreatic cancer, has been associated with considerable morbidity rates (40%-60%) and mortality rates (20%-30%). Even after resection, the prognosis is poor, and as a result some physicians have kept a nihilistic approach; Gudjonsson concluded in his review that pancreatic resections are a waste of resources.' During the last decade, mortality rates have decreased dramatically to less than 5% in centers with experrence, and have led to a more oprimistic view in favor of resection.

Abstract

The surgeon's working environment has changed continuously in recent years regarding the technical complexity of the components in use in the operating room (OR). Parallel to this development, demands for process-optimized procedures have also grown constantly. The impetus for these changes was the beginning of use of minimally invasive techniques in surgery. In contrast, overall development of the OR itself has been slight or nonexistent. What we are typically confronted with currently is an OR outfitted with high-tech medical equipment, whereas only to a limited extent can the design of the OR itself be regarded as ergonomic or holistic. This situation has spread to related specialties as well, and represents a general tendency. Whereas dentists, for example, already enjoy the benefits of a centralized management and operation workplace, this development has not yet reached a satisfactory level for surgeons.

Abstract

Leiomyosarcoma of the vulva is a rare gynaecological malignancy. To date, only few cases have been reported in the literature, the majority of which are from Western countries. Although leiomyosarcoma is classically regarded as a malignant tumor, the generally favorable prognosis following surgical treatment, as well as its reduced propensity for widespread metastasis, makes it one of the most enigmatic malignancies in the medical literature. In addition, the tumor may attain enormous morphological proportions, a situation unusual in many malignant tumors.