[Minimally invasive and intraoperative endoluminal vascular surgery. Critical overlapping and differentiation]. / Minimal invasive und simultan offene und endovaskuläre Gefässeingriffe. Uberschneidungen und Abgrenzungen.

UNLABELLED: There are only four therapeutic options in minimally invasive vascular surgery. Combined open and endoluminal vascular repair is used most often to minimize surgical trauma. This procedure carries the risk of unfavorable long-term results, which must be hazarded in most elderly and critically ill patients. These new therapeutic procedures require a new generation of vascular surgeons. Besides endovascular surgery there is a new and interesting use of laparoscopic aortic surgery, which competes with endovascular surgery. Also endoscopic vein harvesting for bypass surgery is an interesting procedure to minimize surgical trauma. Minimally invasive procedures for varicose vein disease must be considered fashionable surgery and not aimed at minimizing surgical trauma since cosmetic aspects play an important role. CONCLUSIONS: Minimally invasive surgery does not yet play a major part in vascular surgery. Only combined open and endoluminal vascular repair is on the advance in vascular departments. Because of the increases in the incidence of vascular diseases and the use of new expensive therapeutic procedures that drain health care resources on the one hand and because of the controversy involved in allocating patients to different vascular specialists on the other hand, there is a large amount of dynamite in vascular politics that gives us a thrill for the future!

[Evoked potentials for quality assurance in carotid surgery--a cost effectiveness analysis]. / Evozierte Potentiale zur Qualitätssicherung in der Carotischirurgie--eine Kosten-Nutzen-Analyse.

In order to evaluate the relation between costs and benefit of the use of a temporary shunt during surgery of the carotid artery, we analysed 356 patients undergoing 401 operations of the carotid artery in a period from January 1991 to August 1995 in a retrospective study. The morbidity and mortality during hospital stay were 1.75% respectively 0.75% referring to neurological outcome and death. The potential to economize surgery of the carotid artery by recording the somatosensory evoked potentials in order to select the patients requiring a temporary shunt would be 4.1% of the payment which will be payed from 1996 by the social insurance for carotid endarterectomy. These savings can be realized without loss of quality or higher risk for the patient.

[Peritoneal and subcutaneous administration of cefazolin as perioperative antibiotic prophylaxis in colorectal operations. Prospective randomized comparative study of 200 patients]. / Peritoneale und subkutane Applikation von Cefazolin als perioperative Antibiotikaprophylaxe bei kolorektalen Operationen. Prospektive randomisierte Vergleichsstudie bei 200 Patienten.

The prophylactic effect of a intraoperative intraperitoneal and subcutaneous application of cefazolin versus a single shot i.v. prophylaxis was investigated. Additionally, we registered the concentration of cefazolin in the serum and the peritoneal fluid in 22 patients. We randomized 200 patients of whom 189 were included in the study. Ninety-two patients received the prophylaxis i.v. (group 1) and 97 topically (group 2). In 4 (2.1%) wound infections occurred [3(3.3%) group 1 and 1 (1.0%) in group 2]. The difference was not significant. The concentration of cefazolin in the serum was significantly higher at 1 h and 2 h postoperatively in group 2. We conclude that a topical application of antibiotics is possible to prevent surgical wound infection.