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1.
Surgery ; 168(3): 355-362, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32741622

RESUMO

BACKGROUND: To interview extraordinary women who have made recent significant contributions to the field of colorectal surgery. DESIGN: The authors asked some of the many extraordinary women who have made significant contributions to the field of colorectal surgery to answer several questions. These women were selected from many potential candidates based upon their extraordinary recent contributions to the field of colorectal surgery. These thought leaders were asked about their contributions to colorectal surgery, their mentors, whether they had any women as role models, and, lastly, what they would tell their younger selves. The study was structured to recognize these women for their remarkable recent contributions to colorectal surgery, and we wished to encourage women to pursue leadership in colorectal surgery including the allied fields of colorectal pathology and colorectal imaging. Furthermore, the authors hoped to inspire male colorectal surgeons to actively mentor and help the career development of women colorectal surgeons. The potential limitations of the study include the fact that there are many more well-deserving women who could have been included in the sample survey but, because of space constraints, were not invited. CONCLUSION: Women in colorectal surgery and in the allied specialties of colorectal pathology and colorectal radiology have made many recent major significant contributions to colorectal surgery. The expectation is that the volume and frequency of such contributions as well as the number of women making these contributions should further significantly increase with time.


Assuntos
Cirurgia Colorretal/organização & administração , Liderança , Mentores , Médicas/psicologia , Cirurgiões/psicologia , Escolha da Profissão , Cirurgia Colorretal/estatística & dados numéricos , Cirurgia Colorretal/tendências , Feminino , Humanos , Masculino , Médicas/estatística & dados numéricos , Médicas/tendências , Cirurgiões/estatística & dados numéricos , Cirurgiões/tendências
3.
Zhonghua Wai Ke Za Zhi ; 58(8): 586-588, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727187

RESUMO

Since the 21st century, with the development of minimally invasive surgical technology, the update of comprehensive treatment strategies and the progress of clinical research, colorectal surgery has developed rapidly. However, in recent years, some disputable issues still exist in colorectal surgery, such as transanal total mesorectal excision, pelvic cavity lateral lymph node dissection, the "wait and observe" strategy for clinical complete remission of rectal cancer after neoadjuvant therapy, and robotic colorectal surgical operation. In addition, the application of three dimensions imaging, 4K resolution, 5th generation wireless systems, virtual reality, artificial intelligence and other new techniques may provide extensive space and new opportunity for the development of colorectal surgery. The therapic outcome could be optimized by more relevant clinical research and evidence, which contribute to the standardization of surgical treatment of colorectal cancer.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/terapia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Inteligência Artificial , Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/tendências , Terapia Combinada/tendências , Promoção da Saúde , Humanos , Imageamento Tridimensional , Invenções , Excisão de Linfonodo , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Neoplasias Retais/diagnóstico , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Procedimentos Cirúrgicos Robóticos/tendências , Conduta Expectante
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 15-19, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-31958925

RESUMO

Although the surgical treatment of colorectal disease progresses slowly, with the advancement of minimally invasive surgical techniques, perioperative comprehensive treatment strategies and clinical research in recent years, Chinese colorectal surgery has developed rapidly. Transanal total mesorectal excision, lateral pelvic lymph node dissection,"watch and wait"strategy for clinical complete response of neoadjuvant radiotherapy for rectal cancer, and robotic colorectal surgery are still hot topics in colorectal surgery in recent years. The construction of clinical registry database and clinical research for colorectal cancer surgery are discussed, with a view to combing the development of colorectal surgery for colleagues in the surgical field, and to seek the development of colorectal surgery in China.


Assuntos
Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/tendências , China , Neoplasias Colorretais/terapia , Terapia Combinada/tendências , Humanos , Laparoscopia/tendências , Excisão de Linfonodo , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Procedimentos Cirúrgicos Robóticos/tendências , Conduta Expectante
8.
Female Pelvic Med Reconstr Surg ; 26(2): 86-91, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31990793

RESUMO

BACKGROUND: The rapid uptake of robotic surgery has largely been driven by the improved technical aspects of minimally invasive surgery including improved ergonomics, wristed instruments, and 3-dimensional vision. However, little attention has been given to the effect of physical separation of the surgeon from the rest of the operating team. PURPOSE: The aim of this study was to examine in depth how this separation affected team dynamics and staff emotions. METHODS: Robotic procedures were observed in 2 tertiary hospitals, and laparoscopic/open procedures were added for comparison; field notes were taken instantaneously. One-to-one interviews with theater team members were audio recorded and transcribed verbatim. Qualitative analysis was conducted via grounded theory approach using NVIVO11. RESULTS: Twenty-nine participants (26 interviewed) were recruited to the study (11 females) and 134 (109 robotic) hours of observation were completed across gynecology, urology, and colorectal surgery.The following 3 main themes emerged with compounding factors identified: (a) communication challenge, (b) immersion versus distraction, and (c) emotional impact. Compounding factors included the following: individual and team experience, staffing levels, and the physical theater environment. CONCLUSIONS: Our emergent theory is that "surgeon-team separation in robotic theaters poses communication challenges which impacts on situational awareness and staff emotions." These can be ameliorated by staff training, increased experience, and team/procedure consistency.


Assuntos
Barreiras de Comunicação , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/organização & administração , Procedimentos Cirúrgicos Robóticos , Procedimentos Cirúrgicos Operatórios , Adulto , Atitude do Pessoal de Saúde , Cirurgia Colorretal/métodos , Cirurgia Colorretal/tendências , Feminino , Humanos , Masculino , Salas Cirúrgicas/organização & administração , Pesquisa Qualitativa , Melhoria de Qualidade , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/psicologia , Procedimentos Cirúrgicos Robóticos/normas , Robótica/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/psicologia , Procedimentos Cirúrgicos Operatórios/normas , Procedimentos Cirúrgicos Urogenitais/métodos , Procedimentos Cirúrgicos Urogenitais/tendências
10.
Tech Coloproctol ; 23(10): 965-972, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31598786

RESUMO

BACKGROUND: The economic and clinical benefits of laparoscopic colorectal surgery are proven, yet may be underutilized in appropriate cases, especially in the elderly. Since the elderly constitute the greatest colorectal surgical volume, our goal was to identify trends in utilization and impact of laparoscopy in this cohort. METHODS: A national review of elective inpatient colorectal resections from the Premier Inpatient Database between 2010 and 2015 was performed. Patients were included if elderly (≥ 65 years), then grouped into open or laparoscopic procedures. The main outcome measures were trends in utilization by approach and total costs for the episode of care, length of stay (LOS), readmission, and complications by approach in the elderly. Multivariable regression models controlled for differences across platforms, adjusting for patient demographic, comorbidities and hospital characteristics. RESULTS: In 70,655 elderly patients evaluated, laparoscopic adoption remained lower than open throughout the study period. Rates increased until 2013, then declined, with increasing rates of open surgery. Laparoscopy was associated with significantly lower mean total costs ($4012 less/case), complications and readmissions (36% and 33% less, respectively), and shorter LOS (2.6 less days) than open cases (all p < 0.0001). When complications occurred, they were less severe and the readmission episodes were less costly with laparoscopy than open colorectal surgery. CONCLUSION: The adoption of laparoscopy in the elderly has lagged behind open surgery and even declined in recent years despite being associated with improved clinical outcomes and reduced cost. With this tremendous value proposition to increase use of laparoscopic surgery in the elderly, further work needs to evaluate root causes of the disparity.


Assuntos
Colectomia/tendências , Cirurgia Colorretal/tendências , Pacientes Internados/estatística & dados numéricos , Laparoscopia/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Colectomia/economia , Colectomia/métodos , Cirurgia Colorretal/economia , Cirurgia Colorretal/métodos , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/tendências , Feminino , Humanos , Laparoscopia/economia , Tempo de Internação/estatística & dados numéricos , Masculino
17.
Chirurgia (Bucur) ; 114(2): 167-173, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31060648

RESUMO

In the last decades, surgical techniques have evolved, introducing better, more sophisticated devices, aimed at providing the least traumatizing surgical operations, with improved perioperative and longtime results. Based on the results of randomized control trials, current guidelines recommend laparoscopic approach for the treatment of colonic cancer where there is appropriate expertise. Compared with colonic resection, laparoscopic rectal resections are technically challenging procedures associated with a low adoption rate, high conversion rate, debatable functional and oncological results. These drawbacks created the need for a better tool. Robotic surgery emerged to overcome the limits of laparoscopy in terms of visibility and instrument maneuverability. Laparoscopic approach is best suited for colon and superior rectal cancers, while robotic approach is best indicated in medium and inferior rectal cancers(especially in men with a narrow pelvis and in patients with high BMI). In these cases the robotic approach greatly facilitate the minimally invasive approach and, most of the time, allow preservation of the pelvic autonomic nerves leading to a better quality of life. Due to increased costs and relative unavailability of this method, it is difficult to anticipate if the adoption rate of minimally invasive surgery in colorectal cancer will increase significantly.


Assuntos
Neoplasias do Colo/cirurgia , Laparoscopia , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos , Cirurgia Colorretal/tendências , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Qualidade de Vida , Transferência de Tecnologia , Resultado do Tratamento
20.
In Vivo ; 33(2): 297-302, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30804106

RESUMO

BACKGROUND: Three-dimensional (3D) printing is an emerging and evolving technology with a variety of possible applications in surgery. The purpose of this study was to examine its potential applications in the field of colorectal surgery, as a tool in pre-operative planning and peri-operative navigation, as well as in training. Its cost-efficiency was also examined. MATERIALS AND METHODS: A literature review was conducted on articles specifically presenting various applications of 3D printing in the field of colorectal surgery. PubMed was the primary database researched. RESULTS: A total of seven studies were found to meet the inclusion criteria. The majority of the articles employed 3D printing technology to produce patient-specific anatomic replicas to enhance pre-operative planning, providing satisfactory results. One study used 3D printing technology as a therapy tool, stating superior results over traditional methods. CONCLUSION: 3D printing is a novel technology with a broad spectrum of possible applications in colorectal surgery. Anatomic replicas specific to the anatomy of a patient with acceptable dimensional correlations can be produced using the currently available technology. Surgical and patient training can also be enhanced. Depending on the technology used, costs greatly vary and can thus hinder popularization of this technology in surgery.


Assuntos
Colo/cirurgia , Cirurgia Colorretal/tendências , Impressão Tridimensional/tendências , Reto/cirurgia , Colo/patologia , Humanos , Modelos Anatômicos , Reto/patologia
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