The Surgeon

The hottest area of minimally invasive surgery is now that of NOTES (natural orifice transluminal endoscopic surgery) and SPA (single port access). However, most of the work has been in the laboratory and very little has seen the light of clinical experience. Herein, using a novel Uni-X Single Port Access Laparoscopic System (Pnavel Systems, Morganville, NJ), the authors report successfully performing renal cryotherapy (4), wedge biopsy of a kidney (1), abdominal sacrocolpopexy (4), and even radical nephrectomy (1). The single access port is placed via a 1.5 cm incision; the port has 3 portals for passage of a 5 mm flexible steerable laparoscopic endoscope and 2, 5 mm articulating instruments. Hence, the endoscope and instruments can be triangulated at broader angles than would be possible with straight instruments or a rigid endoscope passed through the same port.

The single SPA nephrectomy did require an extra 10 mm port which was placed where a 4 cm incision was planned in order to remove the kidney intact. All procedures were successfully accomplished; the average hospital stay was 2.8 days. Unfortunately, no data are provided with regard to use of analgesics, in hospital analog pain scores, or short term convalescence. Likewise, at this point there are no financial data provided with regard to cost of the SPA port or the specialized, apparently disposable, articulating/rotating instrumentation. The next challenge is to answer the aphorism: “All things good were once new, but all things new are not necessarily good.”. At this point in time, this new approach could easily be subjected to a prospective randomized study be it for sacrocolpopexy or renal cryotherapy. At the very least, it will need a retrospective controlled analysis in the process of determining its proper place in the less invasive armamentarium.

News source

The use of combination chemotherapy following surgery did not improve survival in patients with gastric cancer, according to a randomized clinical trial published online March 11 in the Journal of the National Cancer Institute.
The only potentially curative therapy currently available for non-metastatic gastric cancer is surgery. Recent studies have suggested that a combination of cisplatin, epirubicin, 5-fluorouracil and leucovorin (PELF) improves outcome in patients with metastatic gastric cancer.
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Allison Gandey

March 10, 2008 (Hollywood, Florida) — National guidelines continue to err on the side of caution when it comes to screening cancer patients. For example, routine computed tomography (CT) scans for lung cancer patients are discouraged, and the evidence does not support the use of posttreatment positron emission tomography (PET) in breast cancer. Experts presenting here at the National Comprehensive Cancer Network (NCCN) 13th Annual Conference debated the pros and cons of imaging in cancer patients.

“There are no absolutes in imaging,” presenter Harmeet Kaur, MD, a radiologist from the University of Texas MD Anderson Cancer Center in Houston, told Medscape Oncology. “In many cases, the CT and PET findings will contradict one another. The only way to deal with these complexities is to take the clinical context into account.”

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In December 2007, a jury awarded a plaintiff $10 million as a result of a doctor accidentally leaving a surgical sponge inside the plaintiff after his procedure. The increasing frequency of such verdicts, in combination with new government mandates regarding patient safety, are leading health-care providers to take a long-overdue look at new technologies designed to reduce so-called “never-events.” This is being accelerated by Medicare and private insurers’ newly announced refusal to reimburse the costs associated with preventable medical errors. Currently, hospitals attempt to prevent retained sponges by requiring nurses to individually hand count all the sponges that will be used in a procedure – tracking the sponge counts on a white board. At the end of the procedure, all sponges – both dirty and clean – are counted again by hand and reconciled with the original count. Leading patient safety researchers estimate that of the average 4,000 sponges a year accidentally left behind in patients, at least 88% percent of cases falsely recorded a correct sponge count. This manual method of counting sponges, which is prone to human error, was first established in the 1940’s with little change in the intervening sixty years.
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