Open low anterior resection (LAR) and abdomino-perineal resections (APR) are not easy procedures, esp. in tight male pelvises. The laparoscopic approach gave us a tool dramatically improving the exposure and making the whole mesorectal excision significantly easier. As frequently in situations like that, we were quite hopeful (and meanwhile biased towards believeing) that the advantages in the laparoscopic LAR and APR would translate in better oncological outcomes.
Dr. Fleshman (Dallas, Texas) was one of the most vocal proponents of the laparoscopic approach and wanted to prove it. He recently published a very well designed study:
Podcasts are regaining attention after the initial hype in the mid 2000s and the subsequent decline of their popularity. I've always thought that podcasts are a great resource for gaining or maintaining knowledge.
Looking for a good surgery podcast, the residents in the center I work in recommended Behind the Knife (BTK). I gave it a try and was pleasantly impressed. It's not ideal but it is very good and well made. In addition, the guys running it, put a great effort in engaging nationwide renown surgeons.
All kind of topics are discussed in BTK incl. ABSITE and Board reviews but also review and analysis of important literature.
I intend to use some of the episodes for complementary information whenever I write about a particular topic.
Here is another list of the episodes and this one offers easier downloads.
A lot, maybe even the majority, of things we do in medicine in general and in surgery in particular, are not evidence based. One of those things, no being supported by good data, is one of the most commonly performed procedures in surgery - closing of the abdominal midline incision.
There is some data supporting the 10mm/10mm running closure with PDS 1 suture. However this data is quite weak and now finally somebody decided to challenge that.
Even before this trial, there was evidence that smaller stitches with a more gentle suture would achieve better results in terms of preventing hernias. However, this paper describes the first double-blind, multicentre, randomised controlled trial addressing this question:
All charity care candidates were rigorously screened by social workers and neuropsychiatric professionals to ensure that they have 1) a strong social support system, 2) a failsafe transportation mechanism to facilitate access to posttransplant clinics, 3) adequate cognitive function to understand the transplant process, and 4) a personality that predicts that the candidate will be reliable to take medications as prescribed and come to clinic appointments as required.
Besides suggesting high preselection bias of the patients in this group, one would wonder whether the protocols in Alabama don't include this kind of evaluation of all patients and not just of the ones who are uninsured.
Portal vein thrombosis (PVT) is such a profound problem that it has been considered to be an absolute contraindication for a liver transplantation (LTx) and I know centers still denying LTx for patients with PVT. In the most cases the donor portal vein is anastomosed with the superior mesenteric vein (SMA) of the recipient using a vascular graft (usually from the same donor). There are some reports about porto-renal anastomoses. The portal vein arterialization (PVA) is the option which recently attracted my interest and I took a look at what was written about this.
This is such good news that I couldn't resist starting with it. :)
I wrote twice aboutthis topic and not only my opinion didn't change, I noticed that the general perception regarding NOTES is meanwhile clearly negative. Even people who are usually more open to new approaches share this position now.
Surgeons need new challenges though and the Single Incision Laparoscopic Surgery (SILS) is offering some. Recently I was on Grand Rounds where a general surgeon from a private practice shared his thoughts and experience with the auditorium about SILS. I was hoping that he would focus more on review of the (still scarcely) available data. He decided to just present some of his cases though: just cholecystectomies.
There is a breakthrough publication in the last Science about successful Teleportation(!) of quantum particles between Australia and Japan.
This is general science and not surgery; I know that but it might have caught me in an optimistic moment because I just started imagining what would be, should we be able to teleport real objects one day.
I am so impressed that I didn't want to let this news just pass by without having noted it. :)
The introduction of the 80-hours week for the residents in the USA brought a lot of unhappy faces in the faculty members. Ever since then the residents have to listen to even more "what-do-you-know" and "when-I-was-a-resident" stories on a daily basis. The generation conflict is remarkably expressed in these conversations and it is caused solely by the attending physicians. They urge the residents to protest against these rules arguing that working more than 80 hours per week is essential for a sufficient education.