About a year ago I wrote about a transgastric approach in some gastroenterological experiments. What happened in this year? Well, there is a development! Let us take a look at a paper published last year in Nature Clinical Practice Gastroenterology & Hepatology - a magazine belonging to the Nature publishing group. This posting is a review of the still veterinary experiments regarding the "natural orifice transluminal endoscopic surgery" (NOTES).
This time the paper is written better. The authors are medical guys who are obviously still in the euphory in front of the possibility to perform "operations" as endoscopists. Though they started thinking about things like indications, complications and techniques.
For me the interest in NOTES-publications remain still in the question about the indication and the risks of this experiment. Therefore I don't want to discuss the other parts of the paper. Also, I will compare the transluminal with the laparoscopic approach only and not with the open surgery, because the laparoscopy is what NOTES competes with.
Every abdominal surgeon has patients with peritonitis. In severe cases, a "second look" should be planned. At least this is the common opinion. A group from Holland published a randomized trial about this topic. Surprisingly the results did not show higher morbidity in the "on-demand" group.
Since the end of the 70-ies, as the radioactive iodine therapy was initiated, the prognosis of the well-differentiated thyroid carcinomas improved like no other. Despite the success of the therapy, about 30% of the papillary thyroid carconimas show a recurrence. Therefore the question about the followup of these carcinomas is quite interesting.
A recent case in my ER offered a very interesting finding. A 1930 born woman from Egypt got a CXR. Among the common findings in the CXR of an elderly woman, a couple of breast implants could be seen. The colleague who had the case did not come to the idea of performing breast exam on the woman. All of us were somehow surprised seeing the implants. I first saw the date she was born and noticed that I never saw breast implants in a woman of this age. But the real surprise was that the patient is of Egyptian origin who never lived outside Egypt, being only a visitor in Germany.
Who could imagine that behind the traditional Muslim dress of a 77yo woman with a headscarf, a couple of 2 big breast implants could be find? Wilhelm Conrad Röntgen made it possible. :)
The title of a paper, recently published in the British Journal of Surgery, is "Influence of sex on expansion rate of abdominal aortic aneurysms".
This paper describes a trial with a very interesting conclusion:
The growth rate of AAA was significantly greater in women than in men. This may have implications for the frequency of follow-up and timing of repair of AAA in women.
The cutoff size for AAA in Germany is 50mm. I know that the NHS in the UK makes possible the treatment of such aneurysms until they reach 55mm. Since years the head of our Vascular Surgery Division considers treating of female aneurysms at 45mm. I have to tell him about this nice paper.
In the beginning of most medical books, one can read that the medicine (and of course the surgery) is an ever growing field. Now we know that the laparoscopic cholecystectomy is a good idea, whereas the laparoscopic hernia repair may not be that of a one. Common sense doesn't need much trials. Therefore I dare to share some thoughts about a recent discussions concerning minimizing the "Minimally Invasive Surgery".
A very interesting trial was published in the current issue of Archives of Surgery. The 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! :)
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 an uncovered stent, pressed against the plaques on the carotid bifurcation, made me feel uncomfortable.
This is a somehow old (mid 2004) but nevertheless 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.