Extinction of Non laparoscopic surgeons
Thomas Anthony Horan
thoran at sarah.br
Mon Apr 2 17:55:22 BST 2007
Dear Ron, Mark et al.
I was so taken aback by Dr. gross comments that I thought I had to write to register my complete agreement with him. :-)
apart from the shocking reality that I have at last found a topic upon which we completely agree, there are other emerging concerns about percs. As Mark alluded there may be a reduction in "acute surgical" complications of bleeding and infection etc. but the incidence of proximal tracheal stenosis seems to be rising.
Tom
> ----------
> From: trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on behalf of Ronald Gross[SMTP:Rgross at harthosp.org]
> Reply To: Trauma & Critical Care mailing list
> Sent: segunda-feira, 2 de abril de 2007 13:20
> To: Trauma & Critical Care mailing list
> Subject: Re: Extinction of Non laparoscopic surgeons
>
> Mark,
> I guess we are gonna have to retrain the guys with the large and infected wounds!! ;-)
> All kidding aside, as the dinosaur of our group (OK, so Len can be in that category too, for argument's sake) I will still do an open trach on the bull-necked patient where the perc trach is going to be too problematic and yes dangerous. And I will do it in the OR if the patient's condition permits. AND, our intensivists are surgeons.....imagine that!
> And as Jeff said earlier, the ENT docs are too busy doing that cosmetic stuff...........things that make you go Hmmmmmmm.
> Take care,
> Ron
>
>
> >>> MARK FORREST <atacc.doc at btinternet.com> 3/30/2007 6:13 PM >>>
> Have to agree with Ian on this one. The intensivists do over 90% of our tracheostomies in the ICU and with kits such as the 'cuffed Melker' we will even manage emergency srugical airways. We have discussed this at length as on the very rare occasions that we do request a surgical trach (usually due to an enlarged thyroid) we are well aware that only one of our general surgeons (>50yrs, like Ian says) actually does them or it will be an ENT surgeon who only does 1 or 2 per year.
>
> Another factor is that we have found that nerly 100% of the surgical trachs get infected and 'mucky' due to the much larger wound. They often ooze or bleed, can sit awkwardly on the neck and heal with a poor comsmetic result!!
>
> Anaesthetists/intensivists have so much experience of difficult airways and so many 'toys' to help.....leave them to it!
>
> Cheers
> Mark F
> Cons Anaes/Crit Care
> UK
>
>
> ----- Original Message ----
> From: Jeffrey Hammond <hammond at umdnj.edu>
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>; Jeffry.Kashuk at dhha.org
> Sent: Friday, 30 March, 2007 11:30:06 PM
> Subject: RE: Extinction of Non laparoscopic surgeons
>
>
> I do not about down under, but in the US there are still open trachs being
> done as part of the general surgical training program, usually on trauma
> patients with cervical spine injuries in which perc trach may be
> contraindicated, or on patients with poor landmarks or such. This has not
> defailted to specialists; the ENT surgeons are too busy doing facial plastic
> surgery. The dedicated trauma surgeon (especially with surgical critical
> care credentials which is becoming the norm) is the last bastion of true
> general surgery. Call one of us.
>
> Jeffrey Hammond MD, MPH
> Chief, Trauma/Surgical Critical Care
> Robert Wood Johnson Medical School
> New Brunswick, NJ
> ph: 732-235-7920
> e-mail: hammond at umdnj.edu
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Ian Seppelt
> Sent: Friday, March 30, 2007 1:37 AM
> To: Jeffry.Kashuk at dhha.org; Trauma & Critical Care mailing list
> Subject: RE: Extinction of Non laparoscopic surgeons
>
> It's not just laparoscopic surgery! I worry a bit about the future "demise"
> of open tracheostomy .....
>
> Intensive care practice has changed radically in the last decade or so, and
> while will obviously vary a bit between institutions and perhaps countries,>
> in Australia the majority of tracheostomies are now being done
> percutaneously by intensivists, and only the "truly difficult" ones are
> being referred to specific surgeons with head and neck expertise. In term of
> training, it means that surgical trainees who used to do all the easy
> tracheostomies do none, because intensive care trainees do all the easy
> tracheostomies. Harder ones are done by specific intensivists with an
> interest, etc. In all, we do over 100 per year in the ICU, of which less
> than 10 are done surgically. Moreover, there is only a small list of
> surgeons in my hospital whom I would ask to get me out of trouble of my own
> creation, and they are all over 50 years old.
>
> So in 20 years time, who is going to rescue my airway disaster when no
> junior surgeons aside from specialist head and neck surgeons do
> tracheostomies any more?!!! [Having said that I have only had to call for
> surgical help once in over 500 tracheostomies, and he just stood next to me
> and reassured me that the mess I thought I had created was actually not such
> a mess at all, but it's going to happen one day...]
>
> Cheers, Ian
>
> Ian Seppelt FANZCA FJFICM
> Senior Staff Specialist
> Dept of Intensive Care Medicine
> The Nepean Hospital, PO Box 63 Penrith NSW 2751 Clinical Lecturer,
> University of Sydney
>
> >>> Jeffry.Kashuk at dhha.org 30/03/2007 1:57am >>>
> This is precisely why the Acute Care Surgery paradigm is so important.
> The comprehensive surgeon in this arena needs to know "maximally invasive"
> as well as minimally invasive techniques...
> Jeffry L. Kashuk, M.D, FACS
> Surgery, Trauma, Surgical Critical Care
> Denver Health Medical Center
> 777 Bannock St, MC 0206
> Denver, CO 80204
> Ph 303-436-6558
> Fax 303-436-6572
>
>
> -----Original Message-----
> From: Jeffrey Hammond [mailto:hammond at umdnj.edu]
> Sent: Wednesday,March 28,2007 11:28 AM
> To: 'Trauma & Critical Care mailing list'
> Subject: RE: Extinction of Non laparoscopic surgeons
>
> Those of us over 50 are beginning to joke that we'll soon need a Fellowship
> in "Open Surgery." Meanwhile, we are now graduating residents who have had
> limited experience in things we once considered not only bread and butter
> (e.g. gastric surgery) but also a required skill set (e.g.CBD explorations).
> I wonder how they'll get out of trouble when we're old and they're operating
> on us!
>
>
> Jeffrey Hammond MD, MPH
> Chief, Trauma/Surgical Critical Care
> Robert Wood Johnson Medical School
> New Brunswick, NJ
> ph: 732-235-7920
> e-mail: hammond at umdnj.edu
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Ronald Gross
> Sent: Wednesday, March 28, 2007 9:28 AM
> To: Trauma & Critical Care mailing list
> Subject: RE: Extinction of Non laparoscopic surgeons
>
> Tim,
>
> Not even in elective surgery - someone is going to have to know how to
> operate on the complications encountered by the video-laparoscopic surgeon
> who doesn't know how to operate under direct vision, or how to open the
> cavity he/she has placed a scope into!
>
> Geez - did I really say what I was thinking???
>
> Best wishes,
> Ron
>
> >>> "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za> 3/28/2007
> >>> 10:14 AM >>>
> Dr Khattar
>
> Extinct in elective surgery maybe......Trauma and emergency general surgery
> and in countries where the socio-economic conditions are poor - not likely!
> We need to have surgeons who can feel comfortable in all cavities and with
> all techniques; this is the palce of the Trauma/Acute Care general surgeon.
>
> Regards
> Tim
> Dr T C Hardcastle
> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU) ATLS instructor
> and DSTC Cape Town Course Director Intern program Coordinator: Surgery M.Med
> (Emergency Medicine) Executive Committee member Clinical Head>
> (Director):
> Diana Princess of Wales Trauma Unit Division of Surgery (General) Room
> 4064
> Department of Surgical Sciences Tygerberg Hospital / University of
> Stellenbosch PO Box 19063 Tygerberg 7505 Western Cape South Africa
> e-mail: tch at sun.ac.za
> Cell: +27824681615
> Office: +27219389281 or 4911 pager 0302
>
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]On Behalf Of rm khattar
> Sent: Wednesday, March 28, 2007 2:46 PM
> To: trauma-list at trauma.org
> Subject: Extinction of Non laparoscopic surgeons
>
>
> I recently came across book on laparoscpy in Urologic
> malignancies in which authors claimed that non
> laparoscopic surgeons would become history.What is the
> opinion of leaders in trauma surgery like
> Karim,Ken,ERF,Tim on this issue? I am and doing
> predominantly open surgery and do not see this
> happening at least in next 20 years.
>
>
>
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