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PubMedDate not supplied

Contributions from surgeons to clinical trials and research on the management of soft tissue sarcoma.

BACKGROUND: Surgical resection is the primary treatment for soft tissue sarcoma. Surgeons are in a position to develop and define appropriate treatment strategies for this disease. In an effort to define the contributions of surgeons to the management of sarcoma, the surgical and clinical oncology literature from January 1983 through June 1996 was reviewed. METHODS: A computerized literature search of the Cancerlit database for January 1983 to June 1996 was performed. The search was limited to the topic of soft tissue sarcoma and was further confined to 15 journals that publish articles relevant to surgical management. These studies were then categorized by multiple parameters and analyzed. RESULTS: The Cancerlit file contained 4478 articles in which sarcoma was the primary topic. When the search was limited to 15 journals frequently read by surgeons, 479 references (11%) were retrieved. Within the surgical literature, 95 of the 479 articles (20%) described prospective studies, of which 33 were prospective and randomized. These studies represent all but three of the prospective randomized trials within the literature during the time period reviewed. The management of patients with sarcoma was evaluated in 26 of the prospective randomized trials; of these, 13 trials evaluated adjuvant chemotherapy, three evaluated adjuvant radiotherapy, and ten evaluated the chemotherapeutic treatment of metastatic disease. Surgical oncologists were the first or senior author on 10 of the 16 prospective randomized studies regarding adjuvant radiation or chemotherapy. Four of the 16 trials evaluating adjuvant therapy contained more than 100 patients, and three of those four were from cooperative group efforts. All but one of the studies of adjuvant therapy with less than 100 patients were from single institutional trials. CONCLUSIONS: Although the surgical and clinical oncology literature on soft tissue sarcoma is composed primarily of retrospective reviews, the prospective randomized trials reported represent almost all of the randomized trials in the literature and have significant contributions from surgeons. Surgeons can guide and design clinical trials, but overall patient accrual as represented by soft tissue sarcoma is low, and may be improved through cooperative group efforts.

General Surgery↗
PubMed2001

[How are beginning students in surgery selected? Results of a survey of German consultant surgeons].

AIM: After finishing medical school it is getting more and more difficult for medical students to get one of the rare positions in a surgical training program. Only a good career plan and an intelligent strategy for the first steps in surgical life seem to be an advantage for that competition. On the other hand the selection of basic surgical trainees only based on the curriculum vitae and brief interviews may not be satisfying. The aim of this investigation was to answer the following questions: 1. How do consultant surgeons select their basic trainees? 2. How important is the applicant's record and the interview? 3. Which educational and personal criteria are important for the selection? 4. How can medical students improve their chance of getting a position in a surgical training program. METHODS: Using an anonymous and standardized questionnaire 39 chiefs of university departments of surgery and 44 consultant surgeons each from general and local hospitals were interviewed concerning their selection process and criteria required for application in their training program. The candidates were chosen from an official address list (Deutsche Chirurgie 98, Berufsverband der Deutschen Chirurgen). The questionnaire was sent to the candidates by official postal service together with a prepaid return envelope. RESULTS: Twenty-eight chiefs of university departments of surgery (71.8%) and 29 (65.9%) and 20 (45.5%) of the interviewed consultant surgeons in general and local hospitals responded to the 89-item questionnaire. It turned out that the majority of applications were send to the clinics at the applicant's initiation. Personal relationships or networks are important. Position advertisements are not important. 85.1% of the responders are satisfied with their procedure of selection, nevertheless, 43.4% are interested in recruiting markets. In detail, chiefs of surgical departments in university clinics get a mean of 12.3 (5-50) applications for basic surgical training per month, consultant surgeons in general hospitals 6.5 (4-20), those in local hospitals 5.6 (2-10). The completion and the contents of the doctor's thesis, former research efforts, foreign languages, computer knowledge and other qualifications are the most important criteria in the selection process. Reliability, loyalty, physical and psychological stability, organising and planning ability, stamina, sociability and independence are the most valued personal skills. CONCLUSIONS: Despite the satisfaction with the established common selection process, the high rate of participation in our study shows how important this subject is ranked by leading surgeons. It turned out that besides professional qualification, personal skills are a major criterion in the selection of basic surgical trainees.

Clinical Competence↗
PubMed2003

The orthopaedic surgeon's role in diagnosing and treating patients with osteoporotic fractures: standing discharge orders may be the solution for timely medical care.

Patients who suffer osteoporotic fractures do not typically receive medical/pharmaceutical treatment for osteoporosis. Orthopedic surgeons are concerned about, but not always diligent in following up on, the medical treatment of their fracture patients. The objective of this study was to determine whether orthopedic surgeons could effectively and consistently refer patients with osteoporotic fractures to a primary care provider (PCP) for possible work-up and treatment of osteoporosis. Fourteen orthopedic surgeons participated in the program. Sixty-nine qualifying patients were >/=50 years old, had a low-energy fracture, and had no prior treatment for osteoporosis. For each patient, two letters requesting a PCP appointment were sent to their PCP: one within 10 days of fracture and another 3-10 weeks after fracture. Patients were also instructed that they might have osteoporosis, and were directed to see their PCP. Results showed that of 69 patients (59 females, ten males: average age 69.5+/-10.9 years), 30 (43.5%) did not see a PCP within 84 days. Thirty-nine (56.5%) patients saw a PCP within 84 days, but osteoporosis was not addressed in four (average days to PCP, 39.8+/-18.6: range 7-78 days). Of patients seen within 84 days, anti-resorptive medications (e.g. bisphosphonate) were started in 21/39 (53.8%), but typically not within 41 days of fracture. Of the 14 orthopedic surgeons, five were non-compliant and seven were inconsistent in their participation, forgetting to send the letters and/or inform patients to make PCP appointments. Standing discharge orders (for medications, PCP follow-up, bone-density scanning, etc.) may be more effective in achieving timely medical treatment for patients of orthopedic surgeons with osteoporotic fractures.

Aged↗
PubMed2002

Surgeon workload and motion efficiency with robot and human laparoscopic camera control.

BACKGROUND: Surgeons are now being assisted by robotic systems in a wide range of laparoscopic procedures. Some reports have suggested that robot-assisted camera control (RACC) may be superior to a human driver in terms of quality of view and directional precision, as well as long-term cost savings. Therefore, we setout to investigate the impact of RACC of surgeon motion efficiency. METHODS: Twenty pigs were randomized to undergo a standardized laparoscopic Nissen fundoplication with either a human or RACC system, the AESOP 2000. All procedures were performed by the same surgical fellow. Time was recorded for dissection and suture phases. Inertial motion sensors were used to monitor both the surgeon's hands and the camera. Digitized data were analyzed to produce summary measures related to overall motion. RESULTS: The operative times were slightly longer with RACC (mean 80.2 +/- 20.6 vs 73.1 +/- 15.4 min, not significant). With regard to operative times and surgeon motion measures, the only statistically significant differences were for setup and breakdown times, which contributed <15% to the total time for the procedure. CONCLUSION: In terms of impact on surgeon motion efficiency and operative time under normal surgical conditions, RACC is essentially the same as an expert human driver. However, careful planning and structuring of the surgical suite may yield some small gains in operative time.

Animals↗
PubMed2002

The surgeon on call is a strong factor determining the use of a laparoscopic approach for appendectomy.

BACKGROUND: Laparoscopic and open approaches are commonly used for appendectomy. No previous studies have specifically examined which factors determine whether a laparoscopic or open approach is used for appendectomy. METHODS: We conducted a retrospective chart review of 140 patients who underwent a laparoscopic (n = 60) or open (n = 80) appendectomy between January 2000 and April 2001 at our hospital. Medical records were reviewed, and the data were analyzed using chi-square analysis, the Wilcoxon rank-sum test, and multivariate logistic regression. We studied patient age, gender, type of surgeon on call, leukocyte count, pathology, and the use of diagnostic imaging to determine whether there was any association with the use of a laparoscopic approach. RESULTS: The type of surgeon on call was strongly correlated with a laparoscopic approach. Of the 61 appendectomies performed by laparoscopic surgeons (those who use laparoscopy for operations other than appendectomies and cholecystectomies), 55 (90%) were laparoscopic and 6 (10%) were open. Of the 79 appendectomies performed by nonlaparoscopic surgeons, 5 (6%) were laparoscopic and 74 (94%) were open (multivariate odds ratio, 136; 95% confidence interval, 39-475; p < 0.001). CONCLUSIONS: The surgeon on call when a patient is admitted is an important factor determining whether a patient will receive a laparoscopic or open appendectomy.

Acute Disease↗
PubMed2005

Technical skills errors in laparoscopic cholecystectomy by expert surgeons.

BACKGROUND: Performing laparoscopic surgery involves a complex cascade of cognitive skills, which may inherently have a constant technical error rate. We assess generic and specific minor and major error rates in laparoscopic cholecystectomies (LCs) performed by consultant surgeons. METHODS: Checklists of generic (11) and specific technical minor (six) and major events (eight) were devised for LCs. Two experienced surgeons assessed each full-length operation blindly and independently. RESULTS: A total of 37 LCs were performed by eight consultants. There were no major intraoperative or postoperative complications. Mean inter-rater reliability was kappa = 0.91 (range 0.80-0.98) for each of the error categories. Error rates were generic (27/407) 6.6%, minor (59/222) 26.6%, and major (8/296) 2.7%, respectively. There was a significant statistical difference between the minor error group and the other groups, p <or= 0.05. CONCLUSIONS: Performing laparoscopic surgery may always have a background technical error rate. Our present study demonstrates a migration of surgical technical errors in expert laparoscopic surgeons. The surgeons migrate technically when they execute a high rate of procedure-specific minor errors. However, when it comes to the major fundamental aspects of the operation, they dynamically adapt and migrate away from performing major technical errors. We aim to continue the study to increase cases, assess trainees as well, and also explore other factors that may affect the surgeon when executing surgical technical tasks.

Adult↗
PubMed2006

Surgeon-initiated screening colonoscopy program based on SAGES and ASCRS recommendations in a general surgery practice.

BACKGROUND: This study aimed to determine the utility of a screening colonoscopy program initiated by general surgeons in an academic center. METHODS: New patients presenting to three general surgeons who met screening colonoscopy indications were asked whether they had undergone colorectal cancer (CRC) screening. The patients who had not undergone CRC screening were offered screening colonoscopies or referred to their gastroenterologists. RESULTS: In the first 9-month period of the program, 200 patients who met the Society of American Gastrointestinal and Endoscopic Surgeons/American Society of Colon and Rectal Surgeons indications for CRC screening were asked whether they had undergone screenings. Only 46% (n = 92) reported any prior appropriate screenings. Of the patients who elected CRC screening by the surgeons, 55 underwent full colonoscopies (2 concurrently with hemorrhoidectomies), and 2 had flexible sigmoidoscopies. As a result of screening, 10 patients (18%) required treatment: 7 had polypectomies, 2 had partial colectomies, and 1 with an indication for surgery deferred treatment. CONCLUSIONS: Most of the patients presenting to the general surgeon likely have not had CRC screening, and diligence in making appropriate recommendations should be routine. Colonoscopic findings requiring intervention are not insignificant.

Academic Medical Centers↗
PubMed2005

Minimal access surgery (MAS)-related surgeon morbidity syndromes.

The benefits of minimal access surgery (MAS) in terms of accelerated recovery, reduced period of short-term disability, and patient outcome account for the widespread use of the laparoscopic approach by the majority of general surgeons. In adopting this approach with its current limitations and poor ergonomics, surgeons have been known to sustain surgery-related injuries encompassed by a spectrum best described as MAS-related surgeon morbidity syndromes, some of which are currently overlooked and poorly researched. Equivalent morbidities including the overuse syndrome (from overuse of certain muscle groups during long operations) have been documented in open surgery but are nowadays rare occurrences. As more advanced MAS operations are performed with long execution times, new patterns of neuromusculoskeletal injuries are being recognized. The surgical fatigue syndrome has also been described, though its complex nature is not fully understood. Virtually little is known on other long-term adverse effects on the surgeon following many years of operating from images displayed on a television monitor or LCD screen, and these include deterioration of visual acuity and function of the ocular muscles responsible for fixation-refixation of the eyeballs. The limited reported literature on the MAS-related surgeon morbidity syndromes identifies certain risk factors for these injuries pertaining to central and peripheral domains. Only improved knowledge of the etiology and underlying ergonomic factors based on investigative studies followed by improved instrumentation and operating room (OR) ergonomics will provide near- and long-term solutions.

Cumulative Trauma Disorders↗
PubMed2006

The role of the surgeon in the evolution of flexible endoscopy.

Several cultures, including the Egyptians, Greeks, Romans, and Arabs, made attempts to view accessible human body cavities using a variety of instruments such as spatulas and specula. The first endoscope was created in 1806 when Phillip Bozzini, a German-born urologist, constructed the lichtleiter, which used concave mirrors to reflect candlelight through an open tube into the esophagus, bladder, or rectum. Maximilian Carl-Friedrich Nitze, another German urologist, produced the first usable cystoscope in 1877 by using series of lenses to increase magnification. He was also the first to place light inside the organ of interest to aid visualization. In 1880 Mikulicz made the first gastroscope using a system similar to Nitze's cystoscope. Modern endoscopy was born with the introduction of the fiberoptic endoscope in the late 1950s. Over the ensuing 50 years endoscopy revolutionized many aspects of the surgeon's practice. Endoscopy can now be used to diagnose and often treat gastrointestinal cancer, hemorrhage, obstruction, and inflammatory conditions. This review was initiated by the SAGES Flexible Endoscopy Committee to chronicle the role of the surgeon in the development and introduction of flexible endoscopy into clinical practice, historically and in contemporary surgery. Flexible endoscopy evolved out of surgeons' need to overcome diagnostic and therapeutic challenges. There have been many recent technological advances that facilitate endoluminal therapies, and flexible endoscopy is now traversing new ground. Surgeons have been major contributors in the development of all aspects of endoscopy. There is a continually expanding list of therapeutic options available to patients. The difficult questions of which procedure, on which patient, and when can be answered best by the surgeon versed in endoscopic, laparoscopic, and open surgical techniques.

Endoscopy↗
PubMed1997

Preoperative testing before carotid endarterectomy: a survey of vascular surgeons' attitudes.

Traditional surgical practice and published consensus statements from major vascular surgery specialty societies have considered contrast arteriography to be a routine part of the diagnostic evaluation prior to carotid endarterectomy (CEA). However, some surgeons now omit routine preoperative arteriography if a technically adequate carotid duplex scan is performed and indications for CEA are clear. To better establish current practice patterns and to characterize vascular surgeons' opinions about the role of preoperative arteriography, the Peripheral Vascular Surgery Society membership was surveyed by mail. Eighty-six percent of the members responded (430 of 502). Ninety-three percent of all patients considered for CEA are evaluated with duplex scanning; 82% with arteriography. While the majority of surgeons typically obtain both a duplex scan and an arteriogram, 70% have performed CEA without a preoperative arteriogram. Brain imaging studies (CT or MRI) are obtained in 26% and MR angiograms in 10% of cases. Seventy-five percent of the surgeons agreed with the statement that CEA without preoperative arteriography is an acceptable practice if appropriate indications for surgery are present. Furthermore, one third believed that CEA without a preoperative arteriogram is generally acceptable (acceptable more than half the time). Respondents were stratified by surgical experience time in practice and practice type. No significant differences in responses were found, suggesting the acceptance of CEA without preoperative arteriography is broad-based. This survey demonstrates changing attitudes among practicing vascular surgeons regarding the necessity for routine arteriography prior to CEA. Carotid endarterectomy on the basis of duplex scanning and clinical assessment should be considered an accepted alternative.

Attitude of Health Personnel↗
PubMed2004

Combined anterior and posterior inguinal hernia repair: intermediate recurrence rates with three groups of surgeons.

BACKGROUND: Use of a bilayer polypropylene mesh device (BPMD) for inguinal hernia repair began in 1998. Intermediate follow-up is now available for patients undergoing repair by three groups of surgeons. METHODS: Surgeons whose practice is dedicated to hernia repair trained preceptors who, in turn, assisted in the training of other surgeons in this new technique. All three groups provided information regarding their recurrence rates with this technique. RESULTS: Recurrence rates were similar for all three groups. Hernia specialists reported three recurrences out of 4,801 repairs. Preceptors reported one recurrence in 3,780 repairs. Other surgeons reported one failure in 3,369 repairs. CONCLUSIONS: Use of the BPMD (Prolene Hernia System) provides reliable results in the hands of hernia specialists, as well as general surgeons whose practices are not concentrated on the management of hernias.

Adult↗
PubMed2006

Strategies of follow-up for colorectal cancer: a survey of the American Society of Colon and Rectal Surgeons.

BACKGROUND: The postoperative surveillance of patients who have undergone curative treatment for colorectal cancer (CRC) is controversial. The aim of this study was to investigate the follow-up practice of colorectal surgeons in the United States. METHODS: A postal survey was sent to 1641 active members of the American Society of Colon and Rectal Surgeons practicing in the United States to assess the frequency of follow-up and the methods used in the surveillance of asymptomatic patients following curative surgery for CRC. RESULTS: Only 582 (36%) of the questionnaires that were sent were returned fully completed. Of these, 173 surgeons (30%) followed their patients according to guidelines. Ninety-four percent of surgeons during the first year and 81% during the second year saw their patients regularly every 3 or 6 months. The most widely used tests were colonoscopy and carcinoembryonic antigen (CEA) testing. There was wide discrepancy in the frequency of follow-up and techniques employed, with only about 50% of surgeons following recommended practice. CONCLUSIONS: Surveillance strategies mainly rely on clinical examination, CEA monitoring and colonoscopy. No clear consensus on surveillance programs for CRC patients exists.

Carcinoembryonic Antigen↗
PubMed2006

Improvement of best practice in early breast cancer: actionable surgeon and hospital factors.

To identify actionable elements for improving best practice, this study examined the relative effects of patient, surgeon and hospital factors on surgical treatment variation of 2,929 early breast cancer patients, diagnosed from January 1998 to January 2002 in the region of the Comprehensive Cancer Centre North-Netherlands. Multilevel logistic regression was used to analyze the hierarchically structured data. Apart from the patient level, 43.3% of the treatment variation was due to the hospital and 56.7% to the surgeon, after adjustment for patient characteristics. Although hospital factors like volume, teaching status, and management and policy contributed to this variation, multidisciplinary care seemed the most important actionable hospital factor. Although the surgeon was shown to be an important starting point for quality improvement, actionable elements seemed difficult to identify as factors like surgeon experience and volume were not conclusive and significant variance on this level remained (sigma2 = 0.149, SE 0.053). We conclude that multidisciplinary care can improve best practice and that further research into actionable surgeon factors is needed.

Adult↗
PubMed2005

Effect of treatment success and empathy on surgeon attributions for back surgery outcomes.

This study examined the effect of conservative and surgical treatment success/failure on attributions by surgeons for low back surgical outcomes. It also examined empathy as a moderator of these attributions. Forty surgeons attributed surgical outcome in a hypothetical patient to physical and psychological factors. Results indicated that surgeons were less likely to attribute the cause of surgical failure to physical factors when the patient had already failed conservative treatment for low back pain. Surgeons also were more likely to attribute failed surgery, relative to successful surgery, to patient psychological factors. An interaction effect indicated that the latter difference was significant only when the patient had previously succeeded at conservative treatment. Empathy moderated this effect: empathic surgeons were less likely to see the failed surgery patient as psychologically culpable. This self-serving attributional style, as moderated by empathy, is discussed regarding its potential impact on patient care and physician judgment processes.

Adult↗
PubMed2005

Surgeons and the spirit: a study on the relationship of religiosity to clinical practice.

This study aimed to identify the religious practices and beliefs of surgeons and the relationship between surgeons' locus of control and religiosity. Thirty-five surgeons completed a survey that included items from the Duke University Religion Index, the Salesian Center Intrinsic Religiosity Scale for Clinicians, and Rotter's Locus of Control Scale. Over 68% of sampled surgeons affirmed that their religious beliefs play a part in their practice, 47% attend religious services at least weekly, and 44% pray daily. There was no correlation between locus of control and religiosity. These results challenge the myth of the egocentric, agnostic surgeon.

Data Collection↗
PubMed1993

Hazard of ionizing radiation to trauma surgeons: reducing the risk.

A study aimed to establish the level of radiation exposure to orthopaedic surgeons involved in the care of injured patients; parts of the body most at risk, and to establishing whether surgeon control of X-ray image intensification reduced the risk. This was conducted on five orthopaedic surgeons regularly involved in musculoskeletal care. Radiation dosage (in millisieverts (mSv) to the body, neck, eyes and hands, was measured by means of dosimeters applied to these areas, before and after surgeon-controlled use of X-ray image intensification. Although all doses measured were within current safety guidelines (1.25 mSv total body dose/month, 3.75 mSv eye dose/month and 12.5 mSv extremity dose/month), the hands were most at risk (maximum recorded dosage 3.95 mSv/month). Control by the surgeons of X-ray image intensification significantly reduced exposure of the hands (P < 0.05).

Eye↗
PubMed1995

Protecting patients when their surgeon or dentist is infected with a blood-borne virus.

The vast majority of surgeons and dentists infected with either hepatitis B or HIV do not transmit these infections to patients. When such transmission from health care provider to patients does occur, the precise mechanism of transmission usually remains enigmatic. Attempts to forestall these rare events have produced substantial debate as well as legislative and regulatory initiatives. The routine immunization of medical and dental students with hepatitis B vaccine will eventually eliminate surgeons and dentists as sources of this infection. Serological screening of surgeons and dentists for HIV infection has been considered impractical. Thus, emphasis has been placed on enhancing measures that reduce the risk of blood contact between health care provider and patient. These include developing safer techniques and procedures. When an infected surgeon or dentist is discovered, a review of their professional circumstances is undertaken. In the US many hepatitis B-infected persons are permitted to continue practice; most HIV-infected persons stop performing invasive procedures. Not completely reassured, some patients inquire of their dentist's or surgeon's HIV antibody status.

Dentists↗
PubMed1995

Determination of surgeon-generated gown pressures during various surgical procedures in the operating room.

BACKGROUND: Patients' blood or other potentially infectious body fluids frequently pass through surgeons' gowns in the operating room. These fluids are absorbed by the scrub suit and can directly contaminate the surgeons' skin. Protective barriers remain an important method of exposure control for many blood-borne pathogens. The efficacy of surgical gowns in preventing this passage or strikethrough has therefore become the focus of much attention. Limited data are available concerning the magnitude and duration of pressure against surgeons' gowns. METHODS: A 32-sensor mat placed in the abdominal area was used to obtain pressure data for 15 surgeons of both sexes performing 20 procedures. RESULTS: The percentage of time any pressure was detected varied from 0% during knee reconstruction to 97.4% for excision of a stomach mass. In 16 procedures, more than 87.8% of pressure contacts were 2 N/cm2 (2.9 psi or less); in addition, more than 80% of the contacts were 15 seconds or less during 13 of the procedures. No correlation was found between the amount of pressure and sex of the surgeon, surgical service, or length of the procedure. CONCLUSIONS: Because pressure is related to the type of procedure, gowns should be chosen to afford protection against fluid strikethrough for the pressures and blood loss anticipated.

Blood-Borne Pathogens↗