Pub Date : 2017-12-01Epub Date: 2017-11-08DOI: 10.1097/IJ9.0000000000000045
Wenxiang Wang, Baihua Zhang, Xu Li, Jie Wu, Zhining Wu, Yan Ding, Desong Yang, Jinming Tang, Min Su, Junliang Ma, Xianman You, Jianping Liang, Yong Zhou
Objective: Minimally invasive esophagectomy (MIE) is increasingly used for the treatment of esophageal cancer. However, MIE via the Sweet approach has seldom been reported owing to the challenging procedure for a mediastinal lymph node. Thus, the approach of MIE via left-sided thoracoscopy coupled with video-assisted cervical mediastinoscopy (MIE-SM) was explored for eradicating the mediastinal lymph nodes and recurrent laryngeal nerve; the incidence of perioperative complications, mortality, and surgical radicality were analyzed.
Materials and methods: Thirty patients with esophageal carcinoma underwent MIE-SM between June 2014 and February 2016. The primary outcome was postoperative morbidity within 2 weeks postsurgery. The secondary outcome was surgical radicality, including the circumferential margins, and the number of lymph nodes dissected.
Results: The MIE-SM was completed in all patients within 367.6±68.7 minutes. The incidences of postoperative morbidities including pulmonary complications, anastomotic leakage, chylothorax, or recurrent nerve injury were 43.3%.
Conclusion: The MIE-SM was utilized for the first time to reduce the disadvantage of purely Sweet and McKeown approach, with favorable efficacy in the mediastinal and laryngeal recurrent nerve lymph node eradication. Thus, MIE-SM might be a promising alternative approach in treating esophageal cancer in selected patients.
{"title":"Minimally invasive esophagectomy via Sweet approach in combination with cervical mediastinoscopy for esophageal squamous cell carcinoma: a case series.","authors":"Wenxiang Wang, Baihua Zhang, Xu Li, Jie Wu, Zhining Wu, Yan Ding, Desong Yang, Jinming Tang, Min Su, Junliang Ma, Xianman You, Jianping Liang, Yong Zhou","doi":"10.1097/IJ9.0000000000000045","DOIUrl":"https://doi.org/10.1097/IJ9.0000000000000045","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive esophagectomy (MIE) is increasingly used for the treatment of esophageal cancer. However, MIE via the Sweet approach has seldom been reported owing to the challenging procedure for a mediastinal lymph node. Thus, the approach of MIE via left-sided thoracoscopy coupled with video-assisted cervical mediastinoscopy (MIE-SM) was explored for eradicating the mediastinal lymph nodes and recurrent laryngeal nerve; the incidence of perioperative complications, mortality, and surgical radicality were analyzed.</p><p><strong>Materials and methods: </strong>Thirty patients with esophageal carcinoma underwent MIE-SM between June 2014 and February 2016. The primary outcome was postoperative morbidity within 2 weeks postsurgery. The secondary outcome was surgical radicality, including the circumferential margins, and the number of lymph nodes dissected.</p><p><strong>Results: </strong>The MIE-SM was completed in all patients within 367.6±68.7 minutes. The incidences of postoperative morbidities including pulmonary complications, anastomotic leakage, chylothorax, or recurrent nerve injury were 43.3%.</p><p><strong>Conclusion: </strong>The MIE-SM was utilized for the first time to reduce the disadvantage of purely Sweet and McKeown approach, with favorable efficacy in the mediastinal and laryngeal recurrent nerve lymph node eradication. Thus, MIE-SM might be a promising alternative approach in treating esophageal cancer in selected patients.</p>","PeriodicalId":42930,"journal":{"name":"International Journal of Surgery-Oncology","volume":"2 11","pages":"e45"},"PeriodicalIF":0.3,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/IJ9.0000000000000045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35710557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2017-11-15DOI: 10.1097/IJ9.0000000000000050
Obada Hasan, Akbar Zubairi, Zohaib Nawaz, Masood Umer
The burden of orthopedic tumor surgery in Pakistan is not known. Similarly the number of procedures being performed for bone and soft tissue surgery are not known. This is even becoming more challenging where the existence of rules and regulations in health care are next to minimal. Furthermore data recording in our country and case registries hardly exist. Despite the lack of information and resources, with high disease burden on community, various providers provide surgical interventions every day in our settings. A lot of tumor surgery is still being done by general surgeons and general orthopedic surgeons who have little knowledge and update about musculoskeletal oncology principles. Lack of subspecialized centers and the high cost of such centers force the patients to visit these surgeons for a highly sophisticated problem like a bone tumor which is the disease of young bones. In this article we will emphasize on the difficulty in establishing an orthopedic tumor service in our part of the world and the consequences including delay in diagnosis, faulty course of management and later decline in functionality, disease progression and increased mortality. We will highlight the principles and stepwise approach of orthopedic tumor surgery and explain the difficulty encountered if these principles are not followed.
{"title":"Establishing musculoskeletal oncology service in resource constrained country: challenges and solutions.","authors":"Obada Hasan, Akbar Zubairi, Zohaib Nawaz, Masood Umer","doi":"10.1097/IJ9.0000000000000050","DOIUrl":"10.1097/IJ9.0000000000000050","url":null,"abstract":"<p><p>The burden of orthopedic tumor surgery in Pakistan is not known. Similarly the number of procedures being performed for bone and soft tissue surgery are not known. This is even becoming more challenging where the existence of rules and regulations in health care are next to minimal. Furthermore data recording in our country and case registries hardly exist. Despite the lack of information and resources, with high disease burden on community, various providers provide surgical interventions every day in our settings. A lot of tumor surgery is still being done by general surgeons and general orthopedic surgeons who have little knowledge and update about musculoskeletal oncology principles. Lack of subspecialized centers and the high cost of such centers force the patients to visit these surgeons for a highly sophisticated problem like a bone tumor which is the disease of young bones. In this article we will emphasize on the difficulty in establishing an orthopedic tumor service in our part of the world and the consequences including delay in diagnosis, faulty course of management and later decline in functionality, disease progression and increased mortality. We will highlight the principles and stepwise approach of orthopedic tumor surgery and explain the difficulty encountered if these principles are not followed.</p>","PeriodicalId":42930,"journal":{"name":"International Journal of Surgery-Oncology","volume":"2 11","pages":"e50"},"PeriodicalIF":0.3,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/IJ9.0000000000000050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35710560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2017-11-14DOI: 10.1097/IJ9.0000000000000046
Masood Umer, Obada H A Hasan, Dawar Khan, Nasir Uddin, Shahryar Noordin
The radiologic workup of musculoskeletal tumors can be both cost-efficient and extremely helpful to the referring clinician if one proceeds in a thoughtful and logical manner. It should be remembered that plain films remain the most reliable imaging method for assessment of both biological activity and probable histologic diagnosis of an osseous lesion. Further investigations are of help to determine the extent of lesion and to help in staging. In order to do this, we have found it useful to include an assessment of 10 determinants in the description of a tumor. If these determinants are accurately described, the correct diagnosis or at least a limited differential diagnosis usually becomes obvious.
{"title":"Systematic approach to musculoskeletal benign tumors.","authors":"Masood Umer, Obada H A Hasan, Dawar Khan, Nasir Uddin, Shahryar Noordin","doi":"10.1097/IJ9.0000000000000046","DOIUrl":"https://doi.org/10.1097/IJ9.0000000000000046","url":null,"abstract":"<p><p>The radiologic workup of musculoskeletal tumors can be both cost-efficient and extremely helpful to the referring clinician if one proceeds in a thoughtful and logical manner. It should be remembered that plain films remain the most reliable imaging method for assessment of both biological activity and probable histologic diagnosis of an osseous lesion. Further investigations are of help to determine the extent of lesion and to help in staging. In order to do this, we have found it useful to include an assessment of 10 determinants in the description of a tumor. If these determinants are accurately described, the correct diagnosis or at least a limited differential diagnosis usually becomes obvious.</p>","PeriodicalId":42930,"journal":{"name":"International Journal of Surgery-Oncology","volume":"2 11","pages":"e46"},"PeriodicalIF":0.3,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/IJ9.0000000000000046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35710558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-01Epub Date: 2017-10-16DOI: 10.1097/IJ9.0000000000000044
Khandker Kawser Sarker, Md Jahangir Kabir, A K M Minhaj Uddin Bhuyian, Md Shahjadul Alam, Fazle Rabbi Chowdhury, M Abdul Ahad, Md Anisur Rahman, M Mizanur Rahman
Background: Like that of other Asian countries gastric cancer (GC) is also a leading cancer in Bangladesh and also a cause for cancer-related mortality. Infection with Helicobacter pylori (H. pylori) is the strongest recognized risk factor for gastric adenocarcinoma. The infection is also prevalent in common people. This case-control study was carried out to find an association between GC and H. pylori infection in the community.
Materials and methods: To evaluate association of H. pylori and carcinoma of stomach this study was conducted at National Institute of Cancer Research & Hospital, Dhaka from January 2013 to December 2014. H. pylori status was determined serologically by using H. pylori kit in the department of Biochemistry laboratory of Bangabandhu Sheikh Mujib Medical University. In total, 114 patients with GC and 520 patients not having GC were studied as controls. Logistic regression method was used to calculate the odds ratio.
Results: Significantly more patients in the case group (86.8%) were found to be seropositive for H. pylori antigen in contrast to the control group (67.5%). All of the cases in the present study were in advanced stage. No significant association between H. pylori seropositivity and tumor location was found. It was noted that undifferentiated gastric carcinoma had slightly more association with H. pylori infection. Younger H. pylori-infected patients had been found to be at higher relative risk for GC than older patients.
Conclusion: As there is a strong association found between GC and H. pylori infection special emphasis to eradicate H. pylori infection might reduce the incidence of this dreadly disease.
{"title":"<i>H. pylori</i> infection and gastric cancer in Bangladesh: a case-control study.","authors":"Khandker Kawser Sarker, Md Jahangir Kabir, A K M Minhaj Uddin Bhuyian, Md Shahjadul Alam, Fazle Rabbi Chowdhury, M Abdul Ahad, Md Anisur Rahman, M Mizanur Rahman","doi":"10.1097/IJ9.0000000000000044","DOIUrl":"https://doi.org/10.1097/IJ9.0000000000000044","url":null,"abstract":"<p><strong>Background: </strong>Like that of other Asian countries gastric cancer (GC) is also a leading cancer in Bangladesh and also a cause for cancer-related mortality. Infection with <i>Helicobacter pylori</i> (<i>H. pylori</i>) is the strongest recognized risk factor for gastric adenocarcinoma. The infection is also prevalent in common people. This case-control study was carried out to find an association between GC and <i>H. pylori</i> infection in the community.</p><p><strong>Materials and methods: </strong>To evaluate association of <i>H. pylori</i> and carcinoma of stomach this study was conducted at National Institute of Cancer Research & Hospital, Dhaka from January 2013 to December 2014. <i>H. pylori</i> status was determined serologically by using <i>H. pylori</i> kit in the department of Biochemistry laboratory of Bangabandhu Sheikh Mujib Medical University. In total, 114 patients with GC and 520 patients not having GC were studied as controls. Logistic regression method was used to calculate the odds ratio.</p><p><strong>Results: </strong>Significantly more patients in the case group (86.8%) were found to be seropositive for <i>H. pylori</i> antigen in contrast to the control group (67.5%). All of the cases in the present study were in advanced stage. No significant association between <i>H. pylori</i> seropositivity and tumor location was found. It was noted that undifferentiated gastric carcinoma had slightly more association with <i>H. pylori</i> infection. Younger <i>H. pylori</i>-infected patients had been found to be at higher relative risk for GC than older patients.</p><p><strong>Conclusion: </strong>As there is a strong association found between GC and <i>H. pylori</i> infection special emphasis to eradicate <i>H. pylori</i> infection might reduce the incidence of this dreadly disease.</p>","PeriodicalId":42930,"journal":{"name":"International Journal of Surgery-Oncology","volume":"2 10","pages":"e44"},"PeriodicalIF":0.3,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/IJ9.0000000000000044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35643724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01Epub Date: 2017-10-10DOI: 10.1097/IJ9.0000000000000043
Kara Rossfeld, Erinn M Hade, Alexandra Gangi, Matthew Perez, Emily N Kinsey, Joanna Grabska, Ashley Ederle, Jonathan Zager, April K Salama, Thomas E Olencki, Georgia M Beasley
Immune checkpoint inhibitors have dramatically changed the prognosis for patients with metastatic melanoma. However, not all patients respond to therapy and toxicities can be severe leaving need for reliable clinical predictive markers.
Methods: We examined primary tumor characteristics including ulceration, BRAF mutation status, and Breslow depth in patients who subsequently developed stage IV disease and were treated with ipilimumab at 3 institutions. Patients in this study were not treated on clinical trials. To investigate the relationship between patient characteristics at the time of diagnosis and survival following melanoma diagnosis we utilized Cox proportional hazards models, accounting for delayed entry into the study cohort. Cox models estimate the age and institution adjusted hazard ratios for risk of death.
Results: Of patients (n=385) treated with ipilimumab for stage IV melanoma, 302 met inclusion criteria. The complete response to ipilimumab was 5%, partial response was 13%, 18% had stable disease, 62% had progressive disease, and 5 unknown. The median overall survival rate was 2.03 years [95% confidence interval (CI): 0.13, 3.05]. Primary tumor Breslow depth, lymphovascular invasion, BRAF status, and ulceration did not predict sensitivity to ipilimumab. In this study patient cohort, BRAF mutation (adjusted hazard ratio: 1.43, 95% CI: 0.98, 2.07) and presence of ulceration (adjusted hazard ratio: 1.47, 95% CI: 0.95, 2.26) contributed to an increased risk of death.
Conclusions: The presence of ulceration did not correlate with sensitivity to ipilimumab. Ulceration of the primary tumor and a BRAF mutation were moderately associated with worse survival in patients with metastatic melanoma treated with ipilimumab.
{"title":"Metastatic melanoma patients' sensitivity to ipilimumab cannot be predicted by tumor characteristics.","authors":"Kara Rossfeld, Erinn M Hade, Alexandra Gangi, Matthew Perez, Emily N Kinsey, Joanna Grabska, Ashley Ederle, Jonathan Zager, April K Salama, Thomas E Olencki, Georgia M Beasley","doi":"10.1097/IJ9.0000000000000043","DOIUrl":"https://doi.org/10.1097/IJ9.0000000000000043","url":null,"abstract":"<p><p>Immune checkpoint inhibitors have dramatically changed the prognosis for patients with metastatic melanoma. However, not all patients respond to therapy and toxicities can be severe leaving need for reliable clinical predictive markers.</p><p><strong>Methods: </strong>We examined primary tumor characteristics including ulceration, BRAF mutation status, and Breslow depth in patients who subsequently developed stage IV disease and were treated with ipilimumab at 3 institutions. Patients in this study were not treated on clinical trials. To investigate the relationship between patient characteristics at the time of diagnosis and survival following melanoma diagnosis we utilized Cox proportional hazards models, accounting for delayed entry into the study cohort. Cox models estimate the age and institution adjusted hazard ratios for risk of death.</p><p><strong>Results: </strong>Of patients (n=385) treated with ipilimumab for stage IV melanoma, 302 met inclusion criteria. The complete response to ipilimumab was 5%, partial response was 13%, 18% had stable disease, 62% had progressive disease, and 5 unknown. The median overall survival rate was 2.03 years [95% confidence interval (CI): 0.13, 3.05]. Primary tumor Breslow depth, lymphovascular invasion, BRAF status, and ulceration did not predict sensitivity to ipilimumab. In this study patient cohort, BRAF mutation (adjusted hazard ratio: 1.43, 95% CI: 0.98, 2.07) and presence of ulceration (adjusted hazard ratio: 1.47, 95% CI: 0.95, 2.26) contributed to an increased risk of death.</p><p><strong>Conclusions: </strong>The presence of ulceration did not correlate with sensitivity to ipilimumab. Ulceration of the primary tumor and a BRAF mutation were moderately associated with worse survival in patients with metastatic melanoma treated with ipilimumab.</p>","PeriodicalId":42930,"journal":{"name":"International Journal of Surgery-Oncology","volume":"2 9","pages":"e43"},"PeriodicalIF":0.3,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/IJ9.0000000000000043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35285750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01Epub Date: 2017-10-05DOI: 10.1097/IJ9.0000000000000040
{"title":"Sulfonylureas (not metformin) improve survival of patients with diabetes and resectable pancreatic adenocarcinoma: erratum.","authors":"","doi":"10.1097/IJ9.0000000000000040","DOIUrl":"https://doi.org/10.1097/IJ9.0000000000000040","url":null,"abstract":"","PeriodicalId":42930,"journal":{"name":"International Journal of Surgery-Oncology","volume":"2 9","pages":"e40"},"PeriodicalIF":0.3,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/IJ9.0000000000000040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35644737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01Epub Date: 2017-10-10DOI: 10.1097/IJ9.0000000000000042
{"title":"The rising prevalence of obesity: part A: impact on public health: erratum.","authors":"","doi":"10.1097/IJ9.0000000000000042","DOIUrl":"https://doi.org/10.1097/IJ9.0000000000000042","url":null,"abstract":"","PeriodicalId":42930,"journal":{"name":"International Journal of Surgery-Oncology","volume":"2 9","pages":"e42"},"PeriodicalIF":0.3,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/IJ9.0000000000000042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35285749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-01Epub Date: 2017-08-09DOI: 10.1097/IJ9.0000000000000034
Kristen Little
This review was constructed to evaluate the current advancements in the surgical management of colorectal cancer liver metastases. A shift from the classic conservative and palliative management of such cases has begun with transitions toward surgical management. This shift is due to multiple compounding factors of which many are being studied and presented individually. By combing these factors together, this review provides guidance on the most significant preoperative prognostic factors and suggests future treatment goals for these patients. A progressive conversion from conservative to surgical management also presents ethical implications to be considered. This review may direct future research on surgical resection of colorectal cancer liver metastases and provide advantageous information on the value of preoperative prognostic factors and the role of surgical intervention in this patient population.
{"title":"Is a surgical CURE in the future for colorectal cancer liver metastasis?","authors":"Kristen Little","doi":"10.1097/IJ9.0000000000000034","DOIUrl":"https://doi.org/10.1097/IJ9.0000000000000034","url":null,"abstract":"<p><p>This review was constructed to evaluate the current advancements in the surgical management of colorectal cancer liver metastases. A shift from the classic conservative and palliative management of such cases has begun with transitions toward surgical management. This shift is due to multiple compounding factors of which many are being studied and presented individually. By combing these factors together, this review provides guidance on the most significant preoperative prognostic factors and suggests future treatment goals for these patients. A progressive conversion from conservative to surgical management also presents ethical implications to be considered. This review may direct future research on surgical resection of colorectal cancer liver metastases and provide advantageous information on the value of preoperative prognostic factors and the role of surgical intervention in this patient population.</p>","PeriodicalId":42930,"journal":{"name":"International Journal of Surgery-Oncology","volume":"2 8","pages":"e34"},"PeriodicalIF":0.3,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/IJ9.0000000000000034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35644735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-01Epub Date: 2017-08-22DOI: 10.1097/IJ9.0000000000000033
Tobin Joseph
Traditionally, surgical education was imparted through intensive work, practice, and, most importantly, experience. It was estimated that a trainee would work over 30,000 hours before becoming a consultant. The training curriculum has changed substantially on numerous occasions to meet the requirements of the European Working Time Directive. Despite these perceived thefts from surgical experience, there is still little evidence to support a claim that we are producing worse surgeons. We have also seen a shift in the responsibilities of a surgeon. Over time, the field of medicine has become increasingly superspecialized. This has led to surgeons with very specific skillsets, in stark contrast to surgeons of the past, who were able to perform a vast multitude of procedures. This has partly been driven by improvement in patient care, and a desire to become an “expert” in a particular field. In addition, the advancements made in the surgical field have led to a greater number of procedures to learn and master. Therefore, rather than focusing on being competent in a large number of specialties, surgery has changed so that surgeons now focus on maximizing the effectiveness of the tools they have. This has stimulated the need for a new surgical training curriculum, and new educational methods. With a combination of super-specialization and legislative restrictions, we need to develop newways to train new surgeons to an appropriate level so that they can practice independently. One of these key tools is simulation. Simulation has been used in clinical training from as long ago as 600 BC in ancient India. The rapid development of technology in the past few decades has led to the production of simulations in settings similar to real clinical environments. These scenarios can be used to educate surgical trainees on the method of performing a procedure, allowing them to practice a procedure in a safe, nonthreatening environment before applying it in a supervised clinical setting; this type of education is recommended by the Department of Health. There are numerous advantages to the use of simulations. It enables trainees to safely monitor their progress, and it allows trainees to develop an understanding of these clinical scenarios before they are involved with patients. In addition, from a learning point of view, people tend to learn from their mistakes, and simulation provides an artificial environment to make them. This minimizes the risk to the patients and allows the surgeons to learn and perfect new skills. Simulations also allow for a more accurate assessment of a surgeon’s technical abilities. Logbooks from normal practice can be heavily influenced by the conditions under which the procedure is performed (the patient’s condition, the theater environment), whereas simulation allows for a standardized situation and has greater validity in assessing a trainee’s skill. However, it has been difficult to assess the difference in efficacies between animal a
{"title":"A step forward in surgical education?","authors":"Tobin Joseph","doi":"10.1097/IJ9.0000000000000033","DOIUrl":"https://doi.org/10.1097/IJ9.0000000000000033","url":null,"abstract":"Traditionally, surgical education was imparted through intensive work, practice, and, most importantly, experience. It was estimated that a trainee would work over 30,000 hours before becoming a consultant. The training curriculum has changed substantially on numerous occasions to meet the requirements of the European Working Time Directive. Despite these perceived thefts from surgical experience, there is still little evidence to support a claim that we are producing worse surgeons. We have also seen a shift in the responsibilities of a surgeon. Over time, the field of medicine has become increasingly superspecialized. This has led to surgeons with very specific skillsets, in stark contrast to surgeons of the past, who were able to perform a vast multitude of procedures. This has partly been driven by improvement in patient care, and a desire to become an “expert” in a particular field. In addition, the advancements made in the surgical field have led to a greater number of procedures to learn and master. Therefore, rather than focusing on being competent in a large number of specialties, surgery has changed so that surgeons now focus on maximizing the effectiveness of the tools they have. This has stimulated the need for a new surgical training curriculum, and new educational methods. With a combination of super-specialization and legislative restrictions, we need to develop newways to train new surgeons to an appropriate level so that they can practice independently. One of these key tools is simulation. Simulation has been used in clinical training from as long ago as 600 BC in ancient India. The rapid development of technology in the past few decades has led to the production of simulations in settings similar to real clinical environments. These scenarios can be used to educate surgical trainees on the method of performing a procedure, allowing them to practice a procedure in a safe, nonthreatening environment before applying it in a supervised clinical setting; this type of education is recommended by the Department of Health. There are numerous advantages to the use of simulations. It enables trainees to safely monitor their progress, and it allows trainees to develop an understanding of these clinical scenarios before they are involved with patients. In addition, from a learning point of view, people tend to learn from their mistakes, and simulation provides an artificial environment to make them. This minimizes the risk to the patients and allows the surgeons to learn and perfect new skills. Simulations also allow for a more accurate assessment of a surgeon’s technical abilities. Logbooks from normal practice can be heavily influenced by the conditions under which the procedure is performed (the patient’s condition, the theater environment), whereas simulation allows for a standardized situation and has greater validity in assessing a trainee’s skill. However, it has been difficult to assess the difference in efficacies between animal a","PeriodicalId":42930,"journal":{"name":"International Journal of Surgery-Oncology","volume":"2 8","pages":"e33"},"PeriodicalIF":0.3,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/IJ9.0000000000000033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35644734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}