ESVS Volodos Lecture: Innovations and the Hippocratic Oath.

This lecture remembers Professor Nicolai Volodos, a pioneer innovator and a giant in vascular and endovascular surgery, who performed the first endovascular repair of a thoracic aneurysm in 1987 and developed a complex endovascular program by the end of the 1980s. The manuscript recalls major innovations and innovators in vascular surgery, examines the challenges innovators and those who adopt innovations face and discusses the modern meaning of the Hippocratic Oath. The author concludes that surgical innovations are essential to advance cost-effective care, and shared decision making on adopting new therapies by an ethical surgeon and a well informed patient is the cornerstone of ethical patient care.

Bernoulli in the operating room: from the perspective of a cardiac surgeon.

The Bernoullis were one of the most distinguished families in the history of science. It was Daniel Bernoulli who applied mathematical physics to medicine to further his understanding of physiological mechanisms that have an impact even in today's high-end medicine. His masterwork was the analysis of fluid dynamics, which resulted in Bernoulli's law. Most important for cardiac surgery, it describes how a centrifugal pump works within an extracorporeal circulation, lays the basis for measuring a gradient over a stenotic heart valve, and explains how to measure the transit time flow within a bypass graft.

Supplementing the neurosurgical virtuoso: evolution of automation from mythology to operating room adjunct.

A central concept of scientific advancement in the medical and surgical fields is the incorporation of successful emerging ideas and technologies throughout the scope of human endeavors. The field of automation and robotics is a pivotal representation of this concept. Arising in the mythology of Homer, the concept of automation and robotics grew exponentially over the millennia to provide the substrate for a paradigm shift in the current and future practice of neurosurgery. We trace the growth of this field from the seminal concepts of Homer and Aristotle to early incorporation into neurosurgical practice. Resulting changes provide drastic and welcome advances in areas of visualization, haptics, acoustics, dexterity, tremor reduction, motion scaling, and surgical precision.

[Operating rooms during the second half of the 20th century and its change with surgical advances]. / La salle d'opération durant la 2ème moitie du Xxème siècle et ses remaniements avec les progrès chirurgicaux.

With the rise of new specialities after the World War, the number of OP rooms increases. They became gathered on the basement of buildings near the central sterilisation. To enter the OP room, everyone passes through the dressing "sas". "Slippers", uniforms, gloves and many supplies are now for single-use. Electrified operating tables with their own accessories became very useful. Air conditioning is appreciated too in our countries. The operating microscope for ORL, ophthalmology and neurosurgery is used by every one. In cardiology the coronary revascularisation being common stuff, cardiac transplantation (1967) and open-heart surgery received special attention. Vascular surgeons are dedicated to arteritiden, implants, and aortic aneurysms. Urology is focused on renal transplants (since 1959), and more recently on lithotrity and coelioscopic prostatectomy. The coeliosurgery conquered the abdominal pathology and the endoscopic techniques became current. In neurosurgery, stereotaxy to treat parkinson's disease is not used so often since Levodopa exists. But it is still useful to implant brain-stimulating electrodes for refractory parkinson's cases, some other dyskinesias, mental troubles or epilepsies. The neuronavigation brought new possibilities. At century's end, ambulatory surgery reduces surgical costs. Bigger and multidisciplinary theatres are now preferred. The open-heart surgery assisted by computer and robotics is evolving. Finally, we recall OP room accidents, which are not directly dealing with the operation.

A Tribute to William B. Long, Jr., and William B. Long, III: A Celebration of Their Revolutionary Contributions to Trauma Care.

An emergency medical system for trauma care has been conceived in our nation in an effort to improve delivery of emergency care to the accidentally injured patient. There are an estimated 20 million disabling injuries in our nation that should be cared for in trauma centers each year. This report has been written to acknowledge Dr. William Long, Jr., as well as Dr. William B. Long, III, for their unique contributions in establishing the Maryland Statewide Trauma System. Dr. William Long, Jr., played an instrumental role in working with Dr. R Adams Cowley to verify the life-saving value of the Maryland State Police helicopter system. In addition, Dr. Long, Jr., crafted a plan with Dr. R Adams Cowley that allowed Dr. Cowley the autonomy from the University of Maryland Medical School to develop a separate and distinct trauma facility, which is recognized throughout the world. It is indeed fortuitous that Dr. William B Long, III, experienced these landmark changes in trauma care in Maryland, which provided a catalyst for his future career that included extensive training in general surgery in Edinburgh as well as training in trauma surgery with Dr R Adams Cowley. These unique experiences convinced him to expand his training into cardiothoracic surgery. During these academic adventures, he became an international authority on the mathematics of trauma scores, cardiothoracic trauma resuscitation, and the components of a Level I trauma center. These empowering experiences became a catalyst for Dr. William Long, III, to undertake the scientific and clinical studies that would allow him to develop the only American College of Surgeons Committee on Trauma (ACSCOT) Verified Level I Trauma Center in the Pacific Northwest. This report describes in considerable detail Dr. William B. Long, III,'s Trauma Center at Legacy Emanuel Trauma Center (Portland, Oregon) as well as to outline his plans to further improve trauma care in the state of Oregon so that it remains a legacy for his academic career. His dreams for having a comprehensive trauma system in the Pacific Northwest are described in detail so that it an be replicated in our nation and our world.Dr. Long became the Trauma Medical Director for Emanuel Hospital in the Fall of 1983. He began building Emanuel's trauma program by establishing an infrastructure that would support technically advanced ways of restoring life and function. His trauma center consisted of the following components: trauma registry, trauma resuscitation nurse program, direct to operating room policy with unstable trauma patients, anesthesia as part of the trauma resuscitation team, massive transfusion protocol, mobile surgical transport team, outreach to rural communities, recruitment of specialists with interest in trauma care, development of a new trauma physical facility, and the Physician Assistant educational program.

Rethinking theatre in modern operating rooms.

Metaphor is a means through which a widely accepted meaning of a word is used in a different context to add understanding that would otherwise be difficult to conceive. Through etymological and metaphorical associations, we contend that aspects of "theatre" are still relevant in the modern operating rooms and that the use of dramaturgical metaphors can add another layer of understanding about the social reality in this setting. We begin by exploring the historical roots and derivation of the word theatre as it applied to anatomical dissection and surgery. Briefly, we touch on the work of Erving Goffman and examine how his work has been used by others to explore aspects of operating room nursing. Then, drawing on data from a postmodern ethnographic study that has been used to examine communication in operating room nursing, four dramaturgical metaphors are used to illustrate the argument. They are drama, the script and learning the lines, the show must go on, and changing between back stage and front stage. To conclude, the small amount of previously published literature on this topic is compared and contrasted, and the relevance of using dramaturgical metaphors to understand modern operating rooms is discussed. Being able to distinguish between the inherent drama in operating room work and the dramatic realisation of individuals who work within, can help operating room nurses to think differently about, and perhaps re-evaluate their social situation and how they function within it.

Robots in the operating room--the history.

The history of robotics can be traced back to the automata of ancient Greece, but it has only been within the last 50 years that machines have been made to mimic human actions in order to perform labor rather than to entertain and amuse. Furthermore, it has been only within the last 20 years that robotic technology has been applied to the practice of surgery. The goal of this technology has not been to replace the surgeon, but rather to enhance his or her performance with highly advanced tools. We present a brief history of some of the key points in the development of surgical robotics and discuss the advantages and disadvantages of the various US Food and Drug Administration-approved robotic surgical systems and surgical robots in general.

The genesis of neurosurgery and the evolution of the neurosurgical operative environment: part I-prehistory to 2003.

Despite its singular importance, little attention has been given to the neurosurgical operative environment in the scientific and medical literature. This article focuses attention on the development of neurosurgery and the parallel emergence of its operative setting. The operative environment has, to a large extent, defined the "state of the art and science" of neurosurgery, which is now undergoing rapid reinvention. During the course of its initial invention, major milestones in the development of neurosurgery have included the definition of anatomy, consolidation of a scientific basis, and incorporation of the practicalities of anesthesia and antisepsis and later operative technical adjuvants for further refinement of action and minimalism. The progress, previously long and laborious in emergence, is currently undergoing rapid evolution. Throughout its evolution, the discipline has assimilated the most effective tools of modernity into the operative environment, leading eventually to the entity known as the operating room. In the decades leading to the present, progressive minimalization of manipulation and the emergence of more refined operative definition with increasing precision are evident, with concurrent miniaturization of attendant computerized support systems, sensors, robotic interfaces, and imaging devices. These developments over time have led to the invention of neurosurgery and the establishment of the current state-of-the-art neurosurgical operating room as we understand it, and indeed, to a broader definition of the entity itself. To remain current, each neurosurgeon should periodically reconsider his or her personal operative environment and its functional design with reference to modernity of practice as currently defined.

Diseño de salas de cirugía / Operating rooms design and anesthesiologic needs

En este articulo el autor demuestra la necesidad y obligación que tienen los anestesiólogos de participar en el diseño de las salas de cirugia y dar unas pautas para ello

The first modern operating room in America.

The modern OR was a vital addition to aseptic technique and essential to the development of invasive surgery, and many people do not realize that it needed to be "invented." Gustav Neuber, William S. Halsted, Charles McBurney, and others pioneered the necessary changes in practices and the environment to protect the patient from infection. This article presents the history behind the evolvement of the modern OR and discusses changes in the structures of some facilities as awareness increased about the principles of asepsis.