Ethical considerations regarding the implementation of new technologies and techniques in surgery.

Ethical considerations relevant to the implementation of new surgical technologies and techniques are explored and discussed in practical terms in this statement, including (1) How is the safety of a new technology or technique ensured?; (2) What are the timing and process by which a new technology or technique is implemented at a hospital?; (3) How are patients informed before undergoing a new technology or technique?; (4) How are surgeons trained and credentialed in a new technology or technique?; (5) How are the outcomes of a new technology or technique tracked and evaluated?; and (6) How are the responsibilities to individual patients and society at large balanced? The following discussion is presented with the intent to encourage thought and dialogue about ethical considerations relevant to the implementation of new technologies and new techniques in surgery.

Portal vein thrombosis after laparoscopic cholecystectomy.

Introduction: Portal vein thrombosis (PVT) is a relatively uncommon complication after abdominal surgery.

Case Report: We report an even more unusual case of PVT 10 days after an uncomplicated laparoscopic cholecystectomy, believed to be only the fourth reported case in the literature of this rare complication.

Conclusion: Albeit extremely rare, PVT should be included in the differential diagnosis for abdominal symptoms and/or elevated hepatic function tests after laparoscopic cholecystectomy.

Face and construct validity of a computer-based virtual reality simulator for ERCP.

Background: Currently, little evidence supports computer-based simulation for ERCP training.

Objective: To determine face and construct validity of a computer-based simulator for ERCP and assess its perceived utility as a training tool.

Design: Novice and expert endoscopists completed 2 simulated ERCP cases by using the GI Mentor II.

Mesh-free laparoscopic spigelian hernia repair.

Varied Spigelian hernia mesh repair techniques have been described, although evidence suggests laparoscopy results in less morbidity and shorter hospitalization compared with open procedures. Laparoscopic suture repair of Spigelian hernias is rarely reported. Two patients with small Spigelian hernias (< or =2 cm) were diagnosed and repaired laparoscopically using a transabdominal suture technique.

Survey of student education in surgery.

Background: Few data exist comparing medical student surgical education programs across the US and Canada. We conducted a 30-question, Web-based survey of 142 medical schools in the US and Canada about the administration of undergraduate surgical education programs at their institutions.

Study Design: From October 2005 to January 2006, 142 Association of American Medical Colleges (AAMC) medical schools in the US and Canada were asked to complete a 30-item, Web-based questionnaire.

Initial experience with a novel endoscopic device allowing intragastric manipulation and plication.

Background: Current developments in intraluminal and transluminal natural orifice surgery are limited by issues of access, tissue manipulation, and secure tissue approximation/closure. This report describes an initial laboratory experience with a novel tissue approximation and suturing device. The device is deployed via a previously described platform and is 6 mm in diameter.

A cause for conversion of laparoscopic splenectomy: splenic candidiasis.

Laparoscopic splenectomy (LS) is now considered the procedure of choice for removal of the spleen in several hematologic and traumatic splenic conditions. Perisplenitis is still considered a relative contraindication. We report a rare case of isolated splenic candidiasis treated by laparoscopic splenectomy.

Laparoscopic common bile duct exploration.

In recent years, laparoscopic common bile duct exploration has become the procedure of choice in the management of choledocholithiasis in several laparoscopic centers. The increasing interest for this laparoscopic approach is due to the development of instrumentation and technique, allowing the procedure to be performed safely, and it is also the result of the revised role of endoscopic retrograde cholangiopancreatography, which has been questioned because of its cost, risk of complications and effectiveness. Many surgeons, however, are still not familiar with this technique.

Imaging modalities for acute abdominal pain.

The diagnosis of acute abdominal pain remains hinged on the performance of a careful history and physical exam. Five to ten million emergency department visits occur each year for acute abdominal pain, creating a need to achieve improved diagnostic accuracy in an expedient fashion. Technologies such as ultrasound, computed tomography, magnetic resonance imaging, and diagnostic laparoscopy are helping achieve this goal.