Surgery

Article Abstract:

Surgery is an especially broad discipline, and the advances in surgery are equally broad. Laparoscopic surgery is becoming quite common. In this method, a large incision for abdominal surgery is not needed; smaller incisions are made for the insertion of the surgical tools and the laparoscope, which is an optical instrument especially designed for peering inside the abdominal cavity. The method has become common for the surgical removal of the gall bladder, and has the major advantages of rapid recovery and a shorter hospital stay. The technique requires specialized skill and training, and is not a method for improperly trained practitioners. Fetal surgery is a new and promising field of surgery; in 1990, a 24.5-week-old fetus was diagnosed with a diaphragmatic hernia on the basis of ultrasound imaging. Surgery was performed on the fetus in the womb and the hernia corrected. The infant was delivered by cesarean section at 32 weeks. Although respiratory support and further surgery was necessary, the child is now developing normally. A curious finding to arise from fetal surgery is that fetal wounds heal without scarring. Perhaps future research may reveal why this is so. Another aspect of surgery which is rapidly expanding is surgical intervention in the treatment of atherosclerosis. Years of excess cholesterol can result in the formation of fatty lesions called atherosclerotic plaques within arteries. These plaques obstruct blood flow and serve as the starting point for blood clots within critical arteries such as the coronary arteries serving the heart. A surgical technique to bypass of part of the small intestine can significantly reduce the amount of cholesterol in the blood, and in one study the patients who underwent this operation had significantly fewer heart attacks and significantly fewer deaths due to heart disease. This surgical research confirms that lowering blood cholesterol can reduce the risk of heart attacks, but it is not yet clear which patients, if any, should obtain this sort of surgical treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Fetus, Fetal surgery

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Frontiers in surgery: a perspective

Article Abstract:

Two significant advances in surgery have been reported in the October 9, 1991 issue of The Journal of the American Medical Association, one on lung transplantation, by Elbert P. Trulock and his colleagues, and the other on surgical treatment of atrial fibrillation (rapid, irregular heartbeat) by James L. Cox and others. The achievements in lung transplantation are a result of developments in the fields of immunology and surgery. However, most patients with respiratory failure are elderly and suffer from other diseases as well. Lung transplantation is not a desirable option for elderly patients, and the shortage of donor organs is still a limiting factor. Transplant patients also face other obstacles, such as infection and chronic rejection, and so questions of quality of life persist. The maze procedure for surgical treatment of atrial fibrillation described by Cox and others not only benefited individual patients, but clarified the fundamental mechanisms of the condition and prepared the way for further advances. The procedure described by the researchers was made possible by advances in electrophysiologic mapping techniques. At present, medical (as opposed to surgical) management of recurrent atrial fibrillation is not ideal, but the side effects are modest. In light of this, a surgical ''cure'' may be unnecessary, except in cases where persistent fibrillation is life-threatening or likely to cause severe complications. Both of these studies point to the advances made possible by the clarification of underlying physiological processes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Lungs, Atrial fibrillation, Lung transplantation

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General surgery

Article Abstract:

The most important surgical advances are products of the development of less invasive procedures. These new procedures, such as laparoscopic cholecystectomy to remove gallstones, are based on endoscopic and gynecologic techniques. Laparoscopic techniques have the advantages of requiring less recuperation time and less surgical time. Patients can have surgery under local rather than general anesthesia. The smaller incisions required for laparoscopic techniques also cause less trauma to the patient. Large-scale, randomized studies have not yet been applied to determine the efficacy of the new techniques when compared to the more traditional techniques. Catheter-based surgical interventions being used in vascular surgery replace the traditional long incisions with punctures. Knowledge of the necessity of intestinal nutrition in treating trauma patients is due to an increased understanding of the biological basis of organ failure and generalized infection.

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