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P Testas

Publications and source records attributed to P Testas.

At least 19 recordsLinked to original sources
PubMed1995

[Teaching digestive laparoscopic surgery in France: from education to accreditation?].

The extremely rapid development of laparoscopic surgery since 1989 has given evidence, by the increase in the number of local and vital complications, that teaching of laparoscopic surgery is absolutely necessary, especially technical and practical training. Indeed, laparoscopic surgery is not only a new and different way to attain abdominal organs, but it needs also a complete different acquiring of gestures, which are difficult since the eyes and hands are dissociated due to the videotechnics. The University post-graduate training courses (University Diploma D.U.), which were first organized by the authors in Paris and Nice since 1990, have given the best answers to this challenge: training a large number of surgeons in a minimum of time. In 1994, a new Collège of general visceral and digestive surgeons was founded and the teaching conditions have been modified since. This college courses of general and digestive surgery (D.E.S and D.E.S.C respectively) and during post-graduate formation (F.M.C). After having given recommendations for the program of theoretical and practical teaching of laparoscopic surgery, the authors suggest that this teaching should be integrated in graduate courses of general surgery and in post-graduate courses. These courses represent the best training and are the guarantee of good quality and it would be a big error to suppress them. They should continue under the constant control of the French College of Digestive Surgeons and be supervised by the French National order of medical Doctors.

Accreditation↗
PubMed1993

[Celioscopic cholecystectomy].

Laparoscopic digestive surgery is right now like a revolution. The author after a short historic homage to Raoul Palmer who in 1940 realized the first laparoscopy and also to Philippe Mouret and François Dubois who performed the first laparoscopic cholecystectomy in the world in 1987, is doing some comments. The comments are based in the experience of the author who performed in his surgical department about 400 cholecystectomies and another study realized with B. Delaitre on 6512 cases showing a decrease of morbidity however a dramatic increase of biliary complications from 1.0/00 to 1% this leads the author to two type of reflexions. One based on technical problem especially in high frequency surgery the other in training of this new surgical technic and also on rapid extension, sometime anarchistic of the indications of this new digestive laparoscopic surgery. In conclusion, we have to performed clinical research before doing next applications of laparoscopic surgery and keep in mind the necessity for a new technic to be better for patients.

Cholecystectomy, Laparoscopic↗
PubMed1992

[Complications of cholecystectomy by laparoscopic approach. Apropos of 6512 cases].

6,512 laparoscopic cholecystectomies have been performed by 141 surgeons. The lithiasis was uncomplicated in 80% of cases. Conversion from laparoscopy to laparotomy was necessary in 350 cases (5.37%), for technical problems (22 cases), complications (87 cases) or surgical difficulties (241 cases): 107 cholecystitis, 68 adhesions, 14 difficulties in finding the cystic duct and 25 common bile duct stones were the principle surgical difficulties. Among the 304 complications, we have observed 35 general and 251 local complications: 58 haemorrhages, 12 common bile duct lesions (10 cases of iatrogenic trauma and 2 accidental ligations), 4 cystic duct problems and 3 cases of intestinal trauma were the principle per-laparoscopic complications. Among the 164 post-laparoscopies cholecystectomy's complications, we have observed 50 biliary fistulae with 32 requiring further surgery (damage to the common bile duct in 14 cases), 3 common bile duct strictures, 20 haemorrhages (7 requiring further surgery), 31 deep or sub-phrenic abscesses (16 requiring further surgery) and 2 peritonitis after intestinal trauma. We have had 7 deaths (0.10%). Prognostic factors are: 1) The degree of surgeon's experience; the first 50 laparoscopies cholecystectomies performed are more likely to require further surgery (P < 0.05). 2) Cholecystitis with an significantly higher rate of conversion to laparotomy (P < 0.001) and morbidity (P < 0.01). For an experienced surgeon the biliary morbidity is near to that observed in classical cholecystectomy.

Adolescent↗
PubMed1991

Evaluation by women consulting in a family planning centre of their risk of HIV infection.

In order to assess women's self-perception of their risk of infection by HIV, research was performed among 654 women who had consulted in a family planning centre in the Paris region. Of the 452 (69%) women who took part in this research, 77% considered themselves as 'not at risk of carrying the AIDS virus', 11% as 'at risk' and 12% did not give a specific answer. The most important risk factors noted by the patient and the doctor were found to be the number of partners, the use of syringes and the non- or faulty use of condoms. Estimates of the risk of infection by physicians had a high correlation with those of the women, although there were wide differences between the opinions of the six doctors involved. In one case out of three the doctors were unable to decide whether or not their patient was at risk. The evident difficulties experienced by these physicians show an urgent need for the development of specific medical training programmes. The seroprevalence of 2.4% of HIV infection among the women studied, and 1.1% of those who consulted during the study period, confirm the importance of carrying out specific studies on women consulting in family planning centres.

Adult↗
PubMed1990

[A trial of evaluation of cholecystectomy by celioscopic approach. Apropos of 2266 patients].

Facing enthusiasm and critics it is necessary to evaluate new surgical techniques. The aim of our study is to try to evaluate cholecystectomy by laparoscopy. 2266 patients operated on by laparoscopy in France are compared with 3390 patients operated on by laparotomy which were published in 1990 in American surgical revues. Both groups are comparable concerning age of patients and surgical indications. Even if 10% of the patients operated on by laparoscopy needed a laparotomy, the morbidity and the mortality were not significantly different in both techniques. This study allows to conclude that cholecystectomy done by laparoscopy offers the same security to patients than using laparotomy, with in addition a faster and better recovery and a much lower economic cost. However, some problems are not yet resolved, especially the one concerning main bile duct stones and the one concerning the necessity of a special training for these surgical laparoscopic technics.

Adolescent↗