Training, credentialling, and granting of clinical privileges for laparoscopic general surgery

Article Abstract:

Laparoscopic surgery has rapidly gained acceptance among general surgeons, despite the lack of thorough scientific documentation comparing this approach with the traditional open operations. Laparoscopic surgery is a minimally invasive procedure carried out through several small incisions. A laparoscope (instrument for visualizing internal organs) and other surgical instruments are inserted through these incisions. The procedure is then carried out under laparoscopic visualization, with images from the illuminated optic instrument frequently displayed on a video monitor. Individual surgeons wishing to perform specific types of surgery, such as laparoscopic procedures, need to be granted the privilege to perform them by the hospital in which the operation is performed. Each hospital is responsible for developing criteria for granting these privileges; hospitals need guidelines covering the amount and type of additional training necessary to perform laparoscopic procedures. Laparoscopic surgery uses techniques very different from those learned by general surgeons during residency and carried out in practice; therefore, it is appropriate to grant separate privileges to perform laparoscopic surgery. Good training in laparoscopic surgery is available to general surgeons through preceptorships in diagnostic laparoscopy and courses in laparoscopic surgery (including lectures, animal experience and assisting with human surgery). Granting of privileges in laparoscopic surgery at one hospital requires, in addition to adequate training, that the surgeon be proctored or observed, and be certified as competent in the specific area of general surgery involved (for example, to perform biliary tract operations if the privileges are to perform laparoscopic cholecystectomy, removal of the gallbladder). (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Cholecystectomy, Surgical technology, Laparoscopy

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Autopsy in general surgery practice

Article Abstract:

Autopsy involves studying the organs and tissues of the body after death to determine the cause of death and other pathologic conditions. It is the best method for determining the correctness of the selection of treatment for a patient. During this century there has been a steady decrease in the rate of autopsies performed at most hospitals. A study was undertaken of the impact of autopsy on a training program in general surgery. The records of all surgical patients who died (628) between 1984 and 1988 were assessed. The overall autopsy rate was 73 percent. Discrepancies between clinical impression prior to death were correlated with the findings at autopsy. The diagnostic discrepancies ranged from 23 to 39 percent annually. These findings reinforce the educational benefit of autopsy in spite of the increased use of newer sophisticated noninvasive methods of diagnosis. The authors contend that autopsy, with its attendant mortality conference and presentation, is essential for discussions regarding patient care and issues of quality assurance. Autopsy remains the most specific method available today for the identification of errors in diagnosis, treatment, medical judgement and surgical technique. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Causes of, Autopsy, Death

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