Ten years of IRCAD, Barretos, SP, Brazil

Minimally invasive surgery represented a significant milestone in modern surgery; however, continuous innovation and the emergence of new technologies pose new challenges in terms of surgical learning curves since new interventions are associated with increased surgical complexity and a higher risk of complications. For this reason, surgeons are aware of the beneficial effects of "learning before doing" and the importance of safely implementing new surgical procedures in order to obtain better patient outcomes. Considered the largest Latin American training center in minimally invasive surgery, IRCAD Barretos, São Paulo, Brazil, makes it possible to acquire surgical skills through training in different and the most complex areas of medicine, providing the experience of real and simulated situations, with focus on innovation. The center possesses state-of-the-art infrastructure and technology, with a very high-level teaching staff and an affectionate and hospitable reception. Since its inauguration, in 2011, the center has already qualified numerous professionals and has placed the country in a privileged position in terms of surgical knowledge. The present article describes the activities developed over these ten years of the institute in Brazil as the largest training center for surgeons of the continent in order to address the importance of surgical skills training.

Outpatient surgery is the solution at hand for reducing costs and hospital stays for pediatric surgery too: a hospital trial.

BACKGROUND: Outpatient management has proven to be the most useful method of treatment for various minimally complex surgical specialties compared to day-hospital management or ordinary inpatient processes, a fact confirmed by numerous technical documents and works in the literature. METHODS: We analyzed 27,713 surgical interventions carried out in our hospital between 2005 and 2017. This analysis included all interventions for which the indication of the level of care has moved, over the years, to an outpatient setting. We evaluated the direct costs of these services, comparing them by year and by treatment setting. RESULTS: From the analysis of costs in general, for the same number of services, a reduction of 56.6% can be seen in the comparison between 2005 and 2017. In addition, the analysis of the length of stay shows an average reduction in the number of days of hospitalization from 2.9 to 1.2 between 2005 and 2017. On the basis of a large quantity of data, our study confirms that outpatient surgery can have a significant impact in reducing costs and days of hospitalization, even in a pediatric setting, demonstrating that it is the best choice in terms of saving resources and, above all, clinical and organizational appropriateness. CONCLUSIONS: Outpatient surgery is in fact a valuable solution that provides an advantage for both the patient and his/her family, especially in the pediatric field, for the hospital and more generally for the health system as a whole.

[The surgical hepatology in SCS: from the beginning to development].

The article highlights survey stakes of surgical hepatology in world and Russia, and the 20 years experience of the Russian Scientific Center of Surgery named after B.V. Petrovskiy. 472 liver resections were performed during the period. Main indications for surgery were malignant liver tumors, predominantly metastatic (75.8%). Technical and tactical questions, as well as treatment results were discussed. The issue compares own data with world's experience.

Prevention by organization: the story of no. 4 maxillofacial surgical unit in North Africa and Italy during the Second World War.

BACKGROUND: Written to commemorate the 60th anniversary of Victory in Europe, this article outlines the experience of No. 4 Maxillofacial Surgical Unit, stationed near Cassino, Italy, during the Allied assault in 1944. METHODS: Private archive material including the original data and case photography are used to illustrate the problems of severe maxillofacial injury and burns management in the theater of war. Trained by Harold Gillies, Patrick Clarkson was commanding medical officer of this small innovative unit. With his trainee Rex Lawrie, he overcame huge surgical challenges using the tool kit of wartime plastic surgery. RESULTS: Between 1942 and 1945, they managed 5000 casualties, including 3000 maxillofacial injuries and 1000 burns. To cope with such numbers, the Unit developed novel and aggressive strategies that opposed contemporary conservative practices. These included early primary closure of missile wounds to the face, which reduced union time for fractures and halved the number of late sequestrectomies. Early excision and skin grafting of large burns resulted in the successful management of burns of up to 72 percent body surface area, marking a shift toward the modern era of surgical burns excision. Cases presented include the first report of skin grafting to the calvarial diploe and a series of medullary bone grafts to restore frontal contour defects. CONCLUSIONS: The drive to return injured men to duty without evacuation put great evolutionary pressure on the development of plastic surgery, and much is strikingly recognizable in current practice 60 years later. Were these early surgical lessons forgotten?

[Ambulatory surgery in the United States. Reasons of its existence and future]. / La chirurgie ambulatoire aux USA. Ses raisons d'être et son avenir.

Ambulatory surgery has been gaining momentum in the United States over the past decade. This does not result from an initiative taken by the medical profession, but from a government plan aimed at checking the soaring costs of medical care. Since this rise was chiefly caused by hospital costs, the attempted savings have primarily affected our privilege of admitting the patients to hospital as we wanted. It has become impossible to admit a patient to hospital for diagnostic testing. Even for major surgery (such as resection of the esophagus, duodenopancreatotomy, etc.), the patient comes to hospital on the very morning of the operation. In addition, the medical mutual benefit insurance companies, in particular, the HMOs, have decided that some operations must be performed without any stay in hospital. This has resulted in the creation of ambulatory surgery units, which were either integrated in hospital surgery departments, or independent, and of which we discuss the pros and cons. In addition, an infrastructure aimed at facilitating postoperative care at home or in smaller private units has been set up. Laparoscopic surgery has further increased the percentage of ambulatory operations. There certainly will be no retreat now.