从外科医师到外科学家

一名刚完成接受外科专业培训,考试合格的外科医师,他的前面有两条路可供他选择：坏的道路和好的道路。如果向坏的道路走,他可以到达两个终点。（1）不良外科医师：这些医师以医学知识来欺骗病人钱财,或夸大病情,从中获利;（2）低劣外科医师：他们使用不达标或已淘汰的知识和技术治疗病人。另一条道路是向好的道路,但走这条道路是要不断进行终身学习和评核。最终能否成为一名合格或优秀的外科医师,主要靠的是自己的天赋和个人所付出的努力。一名优秀的外科医师如果只是通过手术,他的一生只能造福有限的病人。但是如果一名外科医师通过医学研究,找出一套新学说、新技术,就可使更多的病人受益。能够称为外科宗师,要求能把新学说发扬光大,成家成派。更要有高尚人格和品德,令人敬佩。     

美国胃肠内镜外科医师协会关于腹(胸)腔镜手术准入制度的指南

1 授权原则 前言美国胃肠内镜外科医师协会（Society of American Gastrointestinal Endoscopic Surgeons，SAGES）推荐使用以下指南用以授予能单独完成腹（胸）腔镜操作，或同时进行手或机器人辅助腔镜手术操作的医师从事该项工作的资格。授权的基本前提是该医师必须有充分的判断力并经过严谨培训，从而一旦参与该项手术便能安全顺利地完成，而且必须具备当出现中转开放手术指征时即能完成开放手术的能力。     

《中华现代外科学杂志》免费查阅、全文上网

Thomas Porter McMurray是英国的矫形外科医师，1887年12月5日出生于贝尔发斯特（Belfast），1910年毕业后在利物浦工作，是Robert Jones的外科住院医师（House Surgeon）。1924年到1939年还任利物浦大学矫形外科讲师。1938年他出任利物浦矫形外科的主任（the first Chair of Orthopaedics in Liverpool）。     

美国胃肠内镜外科医师协会关于诊断及治疗性内镜下逆行胰胆管造影术培训指南

1培训 美国胃肠内镜外科医师协会（Society of American Gastrointestinal Endoscopic Surgeons，SAGES）认为有志于从事肝胆胰疾病诊治工作并已接受相关培训的医师方是接受诊断及治疗性内镜下逆行胰胆管造影术（ERCP）培训的适宜对象。欲接受ERCP培训的医师应对自己的能力有充分自信，在往后工作中应完成足量的手术例数以维持其手术熟练程度，并应有志于在此不断前进的领域中努力不懈以提高自身水平。     

外科医师的职业精神

近年来，外科学取得了巨大的进步。例如，介入治疗的引入代替了部分血管外科的手术；外科吻合器技术的应用，使许多肠道吻合更加安全可靠；微创外科的快速发展大大缩短了病人的住院时间；远程外科学（telesurgery）和机器人外科（robotsurgery）的出现使得地处不同国家的外科医师能完成同一台外科手术。所有这些均得益于科学技术的日新月异。然而，对医师的职业精神（professionalism）的要求却远远落后于外科学科本身的发展。特别是在我国，由于国家级继续医学教育的规范尚未出台，各个大学或医学院对医师技术水平的评估和晋升等都有明确的规定，但是对这些医师的学术道德、文化修养、医学伦理知识以及他们的学风、团队精神等诸多方面却缺乏总体的评价。其中职业精神对大多数医师来说仍然是一个新的概念。了解和正确认识职业精神这个概念，从现代医学和伦理学以及社会学的角度去理解医学以外的职业精神，是21世纪医学发展对我们医师提出的更高的要求。     

负压创面治疗技术的研究进展

负压创面治疗技术（negative pressure wound therapy,NPWT）是近十几年来提出并开展的新方法,它包括1993年德国外科医师Fleischmann等最先提出的封闭负压引流（vacuum sealing drainage,VSD）及1997年美国外科医师Argenta和Morykwas首创的封闭负压辅助闭合（vacuum-assisted closure,VAC）两项关键技术。     

第八届中国外科医师年会征文通知

由中国医师协会、中国医师协会外科医师分会（Chinese College of Surgeons,CCS）和欧洲外科学会（European Society of Surgery）主办,北京医师协会、北京医师协会外科医师分会联合主办,北京大学人民医院和北京大学国际医院共同承办的第八届中国外科医师年会和第十九届欧洲外科学会年会（CCS＆ESS 2015）将于2015年5月15日一17日于北京国际会议中心召开。     

第十一届中国医师协会外科医师年会(CCS2018)会议通知

由中国医师协会、中国医师协会外科医师分会（Chinese Clooege of Surgeons,CCS）主办,北京医师协会、北京医师协会外科医师分会联合主办,北京大学人民医院承办的第十一届中国医师协会外科医师年会将于2018年5月17日-20日在北京国际会议中心召开。     

“第八届中国外科医师年会”征文通知

由中国医师协会、中国医师协会外科医师分会（Chinese College of Surgeons,CCS）和欧洲外科学会（European Society of Surgery）主办,北京医师协会、北京医师协会外科医师分会联合主办,北京大学人民医院和北京大学国际医院共同承办的第八届中国外科医师年会和第十九届欧洲外科学会年会（CCS＆ESS 2015）将于2015年5月15日-5月17日于北京国际会议中心召开。     

“首届中美微创外科高峰论坛周”在北京、长春、南京三地隆重举行

由《中国微创外科杂志》（Chinese Journal of Minimally Invasive Surgery，CJMIS）编辑部／编辑委员会、美国腹腔镜内镜外科医师协会（The Society of Laparoendoscopic Surgeons，SLS）、美国腹腔镜内镜外科医师协会杂志（Journal of the Society of Laparoendoscopic Surgeons，JSLS）、     

Are Indian orthopaedic surgeons aware of the health hazards of radiation exposure? A survey and review on awareness and ways to mitigate them

BackgroundStandardized education on the short and long-term health hazards of radiation and thus the awareness regarding current radiation exposure limits is restricted in the field of orthopaedics. There is a lack of awareness regarding the risks related to radiation exposure amongst orthopaedic surgeons and therefore the recommended safety precautions to assess and mitigate these potential risks should be emphasized. Orthopaedic surgeons should adopt the ALARA (as low as reasonably achievable) principle. All precautions should be taken to keep all members of the operation room safe from radiation exposure and safeguard patients too.MethodsThe survey questionnaire developed in consult with senior orthopaedic surgeons and radiation protection officer consisting of 27 questions was conducted among the orthopaedic surgeons and resident doctors.Results15% responders were unaware about risks of radiation exposure in routine orthopaedic surgery and 82% unaware of the recommended yearly allowance per individual. 30% responders were unaware of correct positioning of the C-arm and 44% were unaware regarding the same distance to be maintained from the C-arm to reduce radiation exposure. 27% responders were unaware regarding pulsed fluoroscopy and its benefits. 45% responders were unsure regarding the thickness of the lead apron. 83% never use a thyroid gland shield and none of the responders use leaded eye glasses. Only 11% responders use lead badges for documentation of radiation exposure.ConclusionOrthopaedic surgeons should understand the basics and basis of radiation exposure limits, be familiar with this literature on the incidence of tumors, dermatitis, cancer risk and cataracts and understand the current intraoperative fluoroscopy safety recommendations. The damaging effects to human tissue caused by radiation exposure are documented since the first reports regarding use of radiographs, hence emphasis on radiation safety and protection should be universally incorporated into graduate medical education.     

Limitations to the Value of the Sapphire Trial

The Sapphire trial was organised as a randomised trial to compare carotid endarterectomy (CEA) with carotid angioplasty and stenting (CAS) using a protection device in so called high risk patients. The trial concluded that CEA and CAS were similar as far as stroke and death are concerned but CAS was superior when other complications were taken into account. The trial was flawed for several reasons. It was commercially funded and the inventor of the protection device was one of the investigators and therefore not in equipoise. The end points of the trial favoured CAS by making a biochemical myocardial event an end point. The surgeons doing CEA in the trial did relatively few CEA’S per year and had a high stroke and death rate. These surgeons also excluded over 400 patients from the trial because they were said to be too difficult or risky to operate on. The precise reasons for this exclusion have never been made clear except that the surgeons were probably inexperienced. Finally the patients were heterogeneous, more than 70% being asymptomatic or suffering from recurrent stenosis. For all of these reasons the Sapphire trial’s conclusions that CAS is equivalent to CEA in high risk patients cannot be scientifically justified.     

Limitations to the value of the Sapphire trial

The Sapphire trial was organised as a randomised trial to compare carotid endarterectomy (CEA) with carotid angioplasty and stenting (CAS) using a protection device in so called high risk patients. The trial concluded that CEA and CAS were similar as far as stroke and death are concerned but CAS was superior when other complications were taken into account. The trial was flawed for several reasons. It was commercially funded and the inventor of the protection device was one of the investigators and therefore not in equipoise. The end points of the trial favoured CAS by making a biochemical myocardial event an end point. The surgeons doing CEA in the trial did relatively few CEA'S per year and had a high stroke and death rate. These surgeons also excluded over 400 patients from the trial because they were said to be too difficult or risky to operate on. The precise reasons for this exclusion have never been made clear except that the surgeons were probably inexperienced. Finally the patients were heterogeneous, more than 70% being asymptomatic or suffering from recurrent stenosis. For all of these reasons the Sapphire trial's conclusions that CAS is equivalent to CEA in high risk patients cannot be scientifically justified.     

震后72小时内地震医学救援队心血管外科医师配备的必要性

摘要：四川大学华西医院近年来多次参加汶川、玉树、芦山等地震医学救援。而心血管外科因其专业特殊性在地震医学救援中的作用无法明确,影响医疗救援队伍专业选择。因而,有必要对震后72h内地震医学救援队是否配备心血管外科医师进行探讨。通过2008年“5·12”汶川地震及2013年“4·20”芦山地震心血管外科医师在震后72h内抗震救灾中的工作情况对比,我们认为在震后72h内地震医学救援队心血管外科医师配备是必要的。     

Editorial Commentary: The Great Endoscopically Assisted Bunion Surgery That Will Never Become Popular—I Will Not Try This at Home

Bunion surgery almost invariably involves osteotomies and open incisions. Recently, some surgeons have been performing minimally invasive osteotomies with less morbidity, more rapid healing, and good results. These surgeries are heavily technique dependent, and other surgeons cannot always reproduce these results. Endoscopically assisted bunion surgery yielded excellent results at 10 years in this study but will likely never be used commonly because of the extremely demanding surgical technique and requisite learning curve.     

Use of mesh for hiatal hernia repair: a survey of SAGES members

Background

Mesh use during hiatal hernia repair (HHR) has been suggested to be safe and effective. Concern has been raised about the risk of mesh-related complications, and the higher risk of complications if revisional hiatal surgery is undertaken after mesh has been used. Available data have not established a clear role for mesh in HHR. To assess surgeons’ adoption of the use of mesh for HHR, SAGES members were surveyed regarding their practice related to mesh use for HHR.

Methods

Between April and September 2010, an internet-based survey tool was used to survey SAGES members. Potential participants were contacted via e-mail and invited to complete the survey. Of the 5,323 attempted contacts, 5,024 reached active e-mail accounts. From these, 2,518 members responded (50% response rate).

Results

The majority of respondents currently perform HHR (69%), but only 18% perform more than 20 per year. Of those who perform HHR, 94% use a laparoscopic approach for the majority of repairs. Whereas 25% of surgeons use mesh for the majority of repairs, 23% of surgeons never use mesh. When mesh is used, an absorbable mesh is most commonly used (67%). An onlay technique is used by 93% of respondents. Only 7% of surgeons who have been in practice more than 20?years use mesh compared with 59% of surgeons in practice less than 10?years. Fifty-seven percent of surgeons have never performed revisional foregut surgery on a patient with prior mesh.

Conclusions

Although the majority of surgeons have used mesh for HHR, it is the minority who use it routinely, with younger surgeons more likely to use mesh than older surgeons. Absorbable mesh is most commonly used. When mesh is used, an onlay technique is most commonly used. There is no clear accepted use of mesh in hiatal hernia repair.     

Patella Resurfacing during Total Knee Arthroplasty: Have We Got the Issue Covered?

Background

Management of the patella during total knee arthroplasty (TKA) is controversial. Multiple studies have examined mechanical and clinical results of TKA with native and resurfaced patellae with no clear consensus.

Methods

We surveyed a large cohort of consultant surgeons in a questionnaire based study in order to assess the indications for patella resurfacing and to correlate practice with degree of specialization, experience and volume of procedures performed.

Results

Six hundred and nineteen surgeons were included. The main indication for patella resurfacing was patellofemoral arthritis. The ratio of those who always:sometimes:never resurfaced was 1:2:1 irrespective of experience or volume performed. There was no difference between knee specialists and non-specialists (p = 0.977) or between high and lower volume surgeons (p = 0.826). Senior and high volume surgeons tended to always resurface.

Conclusions

The majority of surgeons only sometimes resurfaced the patella. The number who always and never resurfaced were similar. There was a tendency for more experienced and high volume surgeons to always resurface.     

Surgeons'' concern and practices of protection against bloodborne pathogens.

OBJECTIVE: To evaluate surgeons' concern regarding risk awareness and behavioral methods of protection against bloodborne pathogen transmission during surgery. METHODS: A 29-item questionnaire was sent to 914 surgeons from two universities and two surgical societies. RESULTS: The questionnaire was returned by 768 active surgeons. Slight or moderate concern about contracting human immunodeficiency virus (HIV) was reported by most surgeons; 8% reported extreme concern and 4% reported no concern. In total, 605 surgeons reported having been vaccinated against hepatitis B; surgeons in practice <7 years were most likely to be vaccinated. Most surgeons did not routinely use double gloves: 92 of 768 surgeons reported that they always use double gloves when performing surgery, and 83 reported that they usually use double gloves. There was a statistically significantly higher proportion of surgeons who always or usually use double gloves who also had hepatitis B vaccinations. Most surgeons incorrectly estimated the seroconversion rates with exposure to a patient with HIV (66% incorrect), hepatitis B (88% incorrect), or hepatitis C (84% incorrect). Most surgeons never or rarely report needle-stick injuries, and only 17% always report needle-stick injuries. CONCLUSIONS: Most surgeons underestimate the risk of bloodborne pathogens and do not routinely use double gloves.     

Ruptured aortic aneurysm: the decision not to operate.

Despite published criteria predicting poor survival after operation for ruptured abdominal aortic aneurysm (RAAA), little is known about the factors which influence surgeons not to operate. Questionnaires were sent to all 404 members of the Vascular Surgical Society of Great Britain and Ireland, posing questions about their practices, and factors influencing the decision not to operate (no influence; may influence; seldom operate; never operate). There were 323 responses (81%) and 97% decided not to operate on selected patients. Age over 80 years influenced 77%, and 54% seldom or never operate over age 85 years. The single most influential factor was severe neurological disease (75% seldom or never operate), while cardiac, pulmonary and renal disease influenced 22%, 28%, and 21%, respectively, to operate seldom or never (74% if two or more of these). Other factors which had some influence for most surgeons were cardiac arrest (85%), loss of consciousness (74%), prolonged hypotension (73%), and long-term nursing care (87%). By contrast, factors which influenced few surgeons were haemoglobin < 9 g/dl (30%), absence of a close relative (33%), and medicolegal considerations (22%). These data help to inform the debate about case selection for repair of RAAA.     

Ornipressin in prevention of blindness following blepharoplasty

Summary 1) The authors try to further demystify the pathogenesis of blindness following blepharoplasty, especially in the light of the safety and superiority of Ornipressin as compared to Adrenaline. 2) They are strongly opposed to any intra-orbital infiltration because they believe this to be not only dangerous when it comes to vascular damage or spasm in retinal end vessels, but also completely unnecessary in obtaining sufficient anesthesia and sufficient reduction of bleeding. 3) Intra-orbital infiltrations are the more dangerous since too much is frequently used. The authors estimate that 1 or 1.5 cc of Xylocaine 2% with Ornipressin, exclusively in the subcutaneous plane, should be amply sufficient to produce both good local anesthesia and hemostasis. 4) Post blepharoplasty blindness has never been reported in the ophthalmic literature though many ophthalmic surgeons perform blepharoplasties.Presented at the combined meeting of the Belgian and Dutch Associations of Plastic Surgeons at Maastricht, October 25, 1986