The Solo Surgeon in the Modern Hospital

2019 ◽  
pp. 313-323
Author(s):  
James A. Unti
Keyword(s):  
2012 ◽  
Vol 2 (1) ◽  
pp. 9 ◽  
Author(s):  
Karim Qayumi

The aim of this paper is to provide an analytical survey of the information available on the development of past and present surgical techniques, and to make projections for the future. For the purposes of this paper, the <em>Past</em> starts in the Neolithic period and ends in the 1800s. In this context, I have divided the <em>Past</em> into <em>Prehistoric</em>, <em>Ancient</em> and <em>Middle Ages</em>, and this period ends in the second half of the 19th century when the major obstacles to the further development of surgery, such as overcoming pain and infection, were removed. We will discuss the development of surgical techniques, and the obstacles and opportunities prevalent in these periods. In the context of this paper, the <em>Present</em> begins in 1867, when Louis Pasteur discovered microorganisms, and ends in the present day. There have been many important changes in the development of surgical techniques during this period, such as the transfer of surgery from the unsterile operating room to the modern hospital operating theater, the development of advanced and specialized surgical practices, such as transplants and laparoscopy, and minimally invasive surgical methods, robotic and Natural Orifice Transluminal Endoscopic Surgery. It is very difficult to foresee how surgical techniques will develop in the <em>Future</em> because of the unpredictable nature of technological progress. Therefore, in this paper, the forecast for the <em>Future</em> is limited to the next 50- 100 years and is a realistic calculation based on already existing technologies. In this context, the <em>Future</em> is divided into the development of surgical techniques that will develop in the <em>near</em> and <em>distant</em> future. It is anticipated that this overview will shed light on the historical perspective of surgical techniques and stimulate interest in their further development.


2018 ◽  
Vol 14 (2) ◽  
pp. 44-53
Author(s):  
S. A. Rakul ◽  
K. V. Pozdnyakov ◽  
R. A. Eloev ◽  
N. A. Pliskachevskiy

Objective: analysis of results of the outcomes of surgical treatment for renal tumors in the Saint Petersburg City Hospital No. 40 over the last 5 years and determination the trends.Materials and methods. The study included 293 patients that underwent 296 surgeries for renal tumors. The majority of patients (87.84 %) were diagnosed with localized cancer, whereas locally advanced and metastatic forms were detected in 4.39 and 7.77 % of cases respectively. We performed radical nephrectomy (RNE) or nephron sparing (NS) via open or minimally invasive route (videoendoscopic or robot-assisted surgery using the da Vinci Surgical System).Results. Organ-preserving surgeries were performed in 52.36 % of patients, RNE – in 47.64 % of patients; minimally invasive and open surgeries were conducted in 95.95 and 4.05 % respectively. In individuals with stage cT1a cancer, NS and RNE were performed in 87 and 13 % of cases respectively; in patients with stage cT1b cancer, NS and RNE were performed in 50.82 and 49.18 % of cases respectively. The majority (90.2 %) of patients with renal tumors >7 cm underwent minimally invasive surgeries, primarily RNE. The incidence of severe postoperative complications after NS and RNE was comparable: 5.75–8.06 and 1.67–15.38 % respectively (р = 0.64).Conclusion. Minimally invasive NS is the method of choice for stage сT1 tumors; however, in some cases, we should also consider it for tumors >7 cm. Videoendoscopic surgery is the most preferable option for these patients, whereas robot-assisted techniques should be used for organpreserving surgeries and RNE in difficult cases.


1993 ◽  
Vol 2 (2) ◽  
pp. 193-196 ◽  
Author(s):  
William Knaus

The increasing complexity of modern hospital care and the decisions that must be made were the reasons we began our research on the Acute Physiology, Age and Chronic Health Evaluation (APACHE) project. As a clinician in an intensive care unit (ICU), I felt very uncomfortable making the sorts of decisions that are common today without any source of information or any reference points. These decisions are not avoidable, they are not discretionary, and they are going to become more frequent in the future because we are treating people at later stages of disease.


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