What influences medical students' choice of surgical careers.

BACKGROUND: Recent emphasis in medical education has been to encourage students to pursue primary care careers. This could have a negative impact on applications to surgical residencies. METHODS: To determine what factors are most influential for a student to pursue a surgical career in spite of this environment, third- and fourth-year medical students were surveyed with a 40-item questionnaire. RESULTS: The response rate was 37% (76/205). Those students considering a career in surgery were more likely than their counterparts to be motivated by role models (P <.006), career opportunities (P <.006), and academic opportunities (P <.013) in surgery. They were less likely than their counterparts to be discouraged from surgery on the basis of lifestyle (P <.001), time commitment (P <.001), call schedules (P <.001), or residency length (P <.028). No differences regarding financial rewards, research opportunities, or intellectual challenges were seen between the groups. Neither race nor sex had a significant role in the selection of surgery as a career. CONCLUSIONS: The data suggests that students are more likely to be influenced to pursue surgical careers by offering early exposure to positive role models and career and academic opportunities in surgery. Knowledge of these influences on student career choices should help surgical educators attract and maintain student interest in surgical careers.

Post-laparoscopic cholecystectomy bile leak secondary to an accessory duct of Luschka.

Intraperitoneal bile collection following laparoscopic cholecystectomy has been reported to occur in 0.2-2% of cases and appears to be slightly higher than when the open technique is used. When the injuries of the common bile duct, technical problems with the cystic duct, diathermic injuries to the biliary tree, and iatrogenic interruption of congenital anomalous of the biliary tree are excluded, the iatrogenic transaction of the cholecystohepatic ducts commonly known as the 'Ducts of Luschka' should be considered as the cause of the biliary leak. This article reports a case of bile leakage due to an unrecognized division of a large duct of Luschka within the gall bladder fossa during laparoscopic cholecystectomy and reviews clinical diagnosis, radiological confirmation, and the appropriate treatment for this uncommon complication of laparoscopic cholecystectomy.

Microinvasive laparoscopic cholecystectomy in pediatric patients.

Although cholelithiasis is uncommon in children, its laparoscopic treatment has progressively become more popular among pediatric surgeons. This is due in part to the fact that compared with the open technique, laparoscopic treatment is less invasive as well as more cost-effective. A review of the literature indicates that it has been customary to use at least one 10-mm port to permit application of the 10-mm endoscopic clip applier for ligation of the cystic duct and artery. We report our experience with two patients in whom a laparoscopic cholecystectomy was performed by use of a 5-mm endoscopic clip applier and a 3-mm laparoscope. The application of a 5-mm clip applier obviated the need for a 10-mm port. It also saved an additional step by eliminating the exchange from the laparoscope to the 10-mm endoscopic clip applier through the 10-mm port. Furthermore, the use of a 3-mm telescope through the smallest port (<5 mm) would achieve a better cosmetic outcome.