Research priorities in surgical simulation for the 21st century

BackgroundLaryngeal complications occur in thyroidectomies as a result of several factors, but especially because of nerve damage. We compared intraoperative stimulation neuromonitoring (IONM) with intraoperative continuous electromyographic neuromonitoring (IEM) to evaluate their ability to identify postoperative laryngeal complications.MethodsThis prospective clinical trial included 174 patients (348 nerves) who had both IONM and IEM. We recorded age, sex, pathology, vocal fold motility, and complications.ResultsIONM identified 334 nerves, whereas IEM identified 348. Five patients had transient laryngeal complications, 2 bilateral, and 3 unilateral recurrent laryngeal nerve paresis. In addition, in 2 patients IEM showed placement of the tracheal tube balloon on the vocal folds, which led to correction. Sensitivity and specificity were 96.48% and 100% for IONM and 100% and 100% for IEM, respectively. IONM had a positive predictive value of 100% and a negative predictive value of 36.84%. The positive and negative predictive values of IEM were 100%.ConclusionsBoth techniques identify recurrent laryngeal nerve injuries; however, IEM seems to have an advantage concerning the nonsurgical laryngeal complications and may play a role in preventing morbidity.     

Emerging technologies for surgery in the 21st century.

Laparoscopic surgery is a transition technology that marked the beginning of the information age revolution for surgery. Telepresence surgery, robotics, tele-education, and telementoring are the next step in the revolution. Using computer-aided systems such as robotics and image-guided surgery, the next generation of surgical systems will be more sophisticated and will permit surgeons to perform surgical procedures beyond the current limitations of human performance, especially at the microscale or on moving organs. More fundamentally, there will be an increased reliance on 3-dimensional images of the patient, gathered by computed tomography, magnetic resonance imaging, ultrasound, or other scanning techniques, to integrate the entire spectrum of surgical care from diagnosis to preoperative planning to intraoperative navigation to education through simulation. By working through the computer-generated image, first with preoperative planning and then during telepresence or image-guided procedures, new approaches to surgery will be discovered. These technologies are complemented by new educational opportunities, such as tele-education, surgical simulation, and a Web-based curriculum. Telementoring will permit further extension of the educational process directly into the operating room.     

21世纪循证外科学:困境、挑战和机遇

困境岁末年初,大家总会静下心来回顾过去、展望未来。每年Nature,Science、ASCO评出的10大医学进展,美国时代周刊和伦敦泰晤士报医学头条,中国医学论坛报首页新闻,充斥我们视野的词汇多是“分子靶向”、“抗血管生成”、“干细胞”、“RNAi”、“基因关联分析”、“疫苗研究”、“药物临床试验”、“FDA”……;与此同时手术戒毒被叫停,移植手术需准入,肿瘤微创切除受质疑,癌肿手术从过去切除范围不断扩大到今天理性控制、功能保留、强调生活质量及作为多学科治疗的有机组成。“外科”、“手术”和“切除”这一类字眼似乎逐渐被医学领域…     

Development of endoscopic surgery in the 21st century

After its introduction by Dr. K. Semm in the 1970s and subsequent refinement of laparoscopic cholecystectomy by Dr. Erich Mühe 1985, endoscopic surgery is now commonly performed in clinical practice. Although some institutions have still not embraced these techniques, surgery has been transformed, not only technically but also conceptually, by endoscopic procedures. Less invasive surgery results in a better quality of life for patients. The theme of this centennial anniversary meeting of the Japanese Surgical Society comes from the words of Keio University founder Yukichi Fukuzawa: "Act now for the future." At this meeting, robotic surgery and telesurgery techniques will be presented, and attendees will be updated on the latest developments in the field, including three-dimensional monitoring, telecommunications, robotics, and other new forms of instrumentation and technology.     

Computers and virtual reality for surgical education in the 21st century

Surgeons must learn to perform operations. The current system of surgical resident education is facing many challenges in terms of time efficiency, costs, and patient safety. In addition, as new types of operations are developed rapidly, practicing surgeons may find a need for more efficient methods of surgical skill education. An in-depth examination of the current learning environment and the literature of motor skills learning provides insights into ways in which surgical skills education can be improved. Computers will certainly be a part of this process. Computer-based training in technical skills has the potential to solve many of the educational, economic, ethical, and patient safety issues related to learning to perform operations. Although full virtual-reality systems are still in development, there has been early progress that should encourage surgeons to incorporate computer simulation into the surgical curriculum.     

Paediatric surgery in the 21st century: The future is bright

The future of our society lies with our children, and they should be served best by well‐trained specialist paediatric surgeons. This is now the accepted standard of care in developed countries worldwide. In the present article, we describe the history of development of our specialty over the years, and look forward to the bright future in the coming years.     

The minimally invasive surgical suite enters the 21st century

Most minimally invasive surgical procedures are now performed in operating rooms that were originally designed for traditional open surgery. Laparoscopic instrumentation such as insufflators, light sources, and camera control units must be placed on one or more equipment carts. After the cart has been moved into place, insufflation tubing, video cables, light cords, cautery lines, and foot controls must be positioned and connected. This cart-based paradigm restricts the ergonomic configuration of the operating room and creates potential mechanical, electrical, and biological hazards to the patient and operating room staff. In order to decrease clutter, ease personnel movement, improve ergonomics, maintain the sterile field, and facilitate the use of advanced imaging, communication, and display devices, an appropriately designed operating environment is essential. Herein we detail both the theoretical and practical aspects of the design and describe the implementation and utilization of such a suite in our hospital. These design elements may prove to be critical to the next generation of minimally invasive surgical suites and will facilitate future advanced laparoscopic procedures.     

Tissue engineering: a 21st century solution to surgical reconstruction

Tissue engineering has emerged as a rapidly expanding approach to address the organ shortage problem. It is an "interdisciplinary field that applies the principles and methods of engineering and the life sciences toward the development of biological substitutes that can restore, maintain, or improve tissue function." Much progress has been made in the tissue engineering of structures relevant to cardiothoracic surgery, including heart valves, blood vessels, myocardium, esophagus, and trachea.     

21世纪初肝脏外科展望

肝脏外科已有百余年历史，20世纪中叶由于奠定了肝脏规则性切除的基础而有了实质性进展；1963年Starzl首例肝移植又开创了肝脏外科的一个新纪元；70年代小肝癌切除则较大幅度地提高了肝癌切除后的生存率；微创外科及其观念以及肝癌局部治疗的兴起，对肝脏外科的发展又产生深远影响；近年对肝癌术后复发转移的研究必将导致21世纪肝癌外科发展的重大变化。     

Hunter's legacy and surgical training and competence in the 21st century

John Hunter''s many contributions to surgery include the development of the scientific approach and possibly the first use of evidence-based medicine. This oration, concentrates on two other areas ? first, some of his contributions to orthopaedics and secondly past, present and future surgical training and competence.     

Daily haemodialysis: dialysis for the 21st century

SUMMARY: Most patients with end stage renal disease (ESRD) currently undergo haemodialysis three times a week. In an effort to improve morbidity, mortality and quality of life in such patients, several small clinical studies have been conducted to evaluate the benefit of short daily haemodialysis (over 90–120 min) and nocturnal slow haemodialysis (overnight for 8–10 h). Although limited by study design and small patient numbers, the results of these studies offer promise that patients who undergo daily haemodialysis benefit from improved long-term outcomes. the most striking benefits of daily haemodialysis are improved quality of life and better blood pressure control with fewer or no antihypertensive medications. Other advantages of daily haemodialysis include higher haemoglobin levels with lower erythropoietin dosages, better nutrition and improved energy as a result of more physiological and efficient dialysis. Nocturnal haemodialysis has also been reported to improve sleep apnoea and control plasma phosphate concentration. Economic advantages of daily haemodialysis arise as the result of lower medication costs and less expensive at-home care. Early data suggest that there may be improvements in survival and reduced hospitalization in patients who receive daily versus conventional haemodialysis.