Laparoscopic kidney transplant by extra peritoneal approach: the safe transition from laboratory to the clinic.

The aim of this study is to develop a novel laparoscopic surgery by extra-peritoneal approach for kidney transplant and pave the way of safe transition from laboratory to the clinic. The study was established to explore the feasibility and safety of human laparoscopic kidney transplant. The experiment was first conducted on the deceased animals, then live animals and human cavader before human kidney transplant was approved. The study patient was a 49-year-old male who received the kidney for laparoscopic kidney transplant by extra-peritoneal approach. The control patient received the contralateral kidney for open kidney transplant. The estimated blood loss was minimal during surgery. Both kidneys experienced delayed graft function but the kidneys started function on Day 6 postoperation. The analgesia consumption was significantly less in the study patient. There is no surgical complication during 6-month follow-up. This study has developed a new technique for laparoscopic kidney transplant by extra-peritoneal approach. It has retained the advantages of open kidney transplant, which allows the graft located in the extra-peritoneal space without violating peritoneum. This study has also paved the way of safe transition for a novel laparoscopic surgery from laboratory to the clinic.

Acute colonic pseudo-obstruction following cesarean delivery.

Acute colonic pseudo-obstruction remains an uncommon complication in obstetric practice, but when it occurs, it is most frequently noted after cesarean delivery. Acute colonic pseudo-obstruction is characterized by the findings consistent with large bowel obstruction in the absence of a demonstrable mechanical cause as noted in this case report. We report the occurrence of acute colonic pseudo-obstruction post-cesarean delivery in which prompt recognition of impending cecal perforation allowed appropriate management by tube cecostomy. Although acute colonic pseudo-obstruction is uncommon, it is important that obstetric practitioners recognize this clinical entity as the potentially fatal consequences of cecal perforation can be prevented by tube cecostomy.

Surgeons and cognitive processes.

BACKGROUND: The surgical mind is geared to make important decisions and perform highly skilled tasks. The aim of this review is to explore the cognitive processes that link these actions. METHODS: The core of this review is derived from a literature search of a computer database (Medline). RESULTS AND CONCLUSION: The surgical image is one of action. However, the effective performance of surgery requires more than mere manual dexterity and it is evident that competent surgeons exhibit the cognitive traits that are held by all experts. The changes that are occurring in surgery indicate a need to place greater emphasis on the cognitive processes that underpin the practice of surgery. It is important that surgeons do not become victims of their own cult image.

Metrics for objective Assessment.

As the need for improved methods of assessing surgical competence grows, it is imperative to establish the basic infrastructure to ensure the ability to communicate among educators, education researchers, responsible training bodies, and credentialing boards. A workshop was conducted to provide a foundation for communication and a standardization of definitions, measurements, and criteria. Future conferences and workshops will be needed to review and refine this initial framework.

The development of undergraduate curricula in surgery: II. Generic surgery.

The present paper focuses upon the issues in curricular reform that have specific relevance for surgeons. A central theme is that, taking into account the dual diminution of general surgery and large central teaching hospitals, there is a need to have a clear vision of what should be included in surgical curricula and how we can adjust to new methods of teaching and learning.

The development of undergraduate curricula in surgery: III. Assessment.

The present review is aimed at providing an overview of the assessment process. The mode of assessment has a powerful influence on the learning behaviour of students. It is therefore important to ensure that there is congruity between the objective, the task and the test. In other words: define it, teach it, examine it. It is difficult to evaluate many of the attributes that we desire in a doctor; and examples of this include empathy, ethical behaviour, problem-solving skills, ability to self-educate and teamwork. Nevertheless, it is generally agreed that it is better to measure uncertainly the significant than to measure reliably and validly the trivial. Furthermore different methods of assessment suit different educational objectives (fitness for purpose) and this supports the use of multiple assessment techniques.

The development of undergraduate curricula in surgery: I. General issues.

Undergraduate surgical education is evolving in line with societal changes, the growth of information technology, developments in educational processes, and shifts in the health-care industry. The underlying principles include the establishment of a strong linkage between the objectives and content of curricula, the identification of core knowledge and appropriate attitudes, achieving competence in basic skills, the creation of greater integration, and the promotion of study in depth. The aim of the present paper was to provide surgeons with an overview of these developments.

Acquiring surgical skills.

BACKGROUND: Technical competence is the bedrock of surgery, yet it has only recently been viewed as a valid area for either critical evaluation or formal teaching. METHODS: This review examines the teaching of surgical skills. The core is derived from a literature search of the Medline computer database. RESULTS AND CONCLUSION: The impetus for surgical change has generally related to the introduction of new technology. Advances initially allowed for open operation within the main body cavities; more recently minimal access surgery has appeared. The latter was introduced in an inappropriate manner, which has led to the evolution of teaching of technical skills away from an apprenticeship-based activity towards more formal skill-based training programmes. There is now a need for a solid theoretical base for the teaching of manual skills that accommodates concepts of surgical competence.

TP53 gene mutation status in pretreatment biopsies of oesophageal adenocarcinoma has no prognostic value.

Identification of markers which help to predict response to treatment and overall survival at the time of diagnosis would assist in the management of patients with oesophageal adenocarcinoma. In the present study we investigated the prognostic significance of mutations to the TP53 tumour suppressor gene in a large, consecutive series of oesophageal adenocarcinomas. The incidence of TP53 mutation determined by molecular analysis of endoscopic biopsy specimens was 36% (49/135). No statistically significant difference was observed in patient survival according to the TP53 status of the tumour biopsy. The median survival time for patients with mutation was 12 +/- 1 months compared with 14 +/- 2 months for patients with TP53. These results demonstrate that mutation of the TP53 gene is not a useful predictive marker for patient survival in oesophageal adenocarcinoma.

Developing visiting surgical services for rural and remote Australian communities.

The University Department of Surgery at Queen Elizabeth II Medical Centre (Perth, Western Australia) has undertaken a pilot project to provide surgical services to country communities where no such service exists. Three surgeons undertake a regular schedule of appointments, and are accompanied by final-year medical students to give them experience with common conditions rarely managed in teaching hospitals. The service is supported by a central administrative office and coordinated by a general practitioner, who negotiates with the regional healthcare providers. Patients are referred by their general practitioner, who may work with the surgeon as anaesthetist or surgical assistant.