Surgery for Surgeons

A very interesting trial was published in the current issue of “Archives of Surgery“. The clear conclusion is: “Video game skill correlates with laparoscopic surgical skills. Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery. Video games may be a practical teaching tool to help train surgeons.”

In discussions with colleagues we compared many times the endoscopy (gastroscopy and colonoscopy) with a video game. The students found this talks very funny. Now we have the “proof”! :)

So, dear surgeons: take a good computer machine and play! Play for the sake of your patients! :)

In the last Friday a patient was brought to my ER from the airport. He was previously reported by the control point as a cerebral commotio. He was a man in the 4 decade who flew from a big city in the USA to Europe accompanied by his wife. It was interesting that he is a nephrologist and his wife is a general surgeon. Continue Reading »

First results of the EVA-3S trials were recently published in the NEJM. The conclusion is clear: “In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting.”

OK, I am a surgeon and have the thinking of a surgeon. I always had a bad feeling regarding the carotid stents. The idea of a uncovered stent, pressed against the plaques on the carotid bifurcation, made me feel uncomfortable.
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A 75 yo, previously completely healthy patient came to my ER and complained about upper GI pain for 3 days, no other complains. The exam showed a very painful and tense abdominal wall upon pressure. Labs got some elevated WBC (11.2 Bil/l) without elevated CRP or any other parameter. The abdominal plain is shown on the right (click the thumbnail for a larger view).

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Once again a mid 2004 multicenter trial but very interesting because of the high relevance in the daily practice of surgery.

The conclusion is straight and clear: “..for primary hernias, the open technique of tension-free repair is superior to the laparoscopic technique, both in terms of recurrence rates and in terms of safety.”

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This is a somehow old (mid 2004) but nevertheless very important multicenter trial which aroused my interest due to the fact that I do laparoscopically (hand)assisted colectomies.

The conclusion is: “..the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy, suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer”.

Though, “no advantage of laparoscopically assisted surgery was evident with respect to either all stages of cancer or high-risk subgroups”. The collecting of data for the trial began 1994. Therefore the new, hand assisted approach in the laparoscopic surgery, could not be considered.

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A recent publication from the laboratory institute in the university clinics in Hamburg, Germany discusses a new approach to diagnosing colorectal carcinoma: detection of tumor DNA in stool samples. Here is the abstract of the publication in the german “Aerzteblatt”:

Detection of tumour DNA in stool is a new screening approach aimed at improving the early diagnosis of colorectal cancer. DNA from colorectal adenomas or carcinomas can be detected using specific mutations or methylation patterns. Altered DNA can in principle be detected in a high excess of normal DNA with high sensitivity, but low cost routine screening assays have yet to be developed. The combination of markers and methods must be refined to detect early stage tumours reliably. Only a test with high sensitivity could replace colonoscopy as the recommended screening method in the future.

The guys of the Mayo Clinic performed an interesting retrospective study about new-onset diabetes as a marker of underlying pancreatic cancer. They found that approxymately 1% of diabetes subjects aged > or =50 years will be diagnosed with pancreatic cancer within 3 years of first meeting criteria for diabetes.

Especially in patients with a positive family history for pancreatic carcinoma and a new-onset of DM a suggestion of a follow up would be a good idea.

The day before yesterday I did a cholecystectomy of a patient with a stone passage and elevated transaminases, alcaline phosphatase and bilirubine. At the laparoscopy we saw a liver in an advanced stage of cirrhosis. This explained the preoperative estimated splenomegaly and a consecutive thrombopeny. We discovered that the reason for the liver cirrhosis was a hepatitis C. Neither this condition, nor the cirrhosis or any other finding were known previously. The 46 yo patient lives in Marocco visiting now his brother in Germany and told us that he rarely goes to a physician, who lately (about a year ago) found a diabetes and nothing else (!).

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Yesterday I saw a 20yo female patient who was a driver of a dialysis transport service. It was a very rainy day in Frankfurt and suddenly, in the evening, she slipped with the car (a VW one!) and hit а piller. The airbag opened then against her left forearm which still holded the wheel. Continue Reading »