In an attempt to clearly separate benign from malignant mucinous papillary tumors of the pancreas, Kawai et al have, in a small series, suggested that tumor size larger than 30 mm, mural nodules larger than 5 mm, and carcinoembryonic antigen levels higher than 110 ng/mL in pure pancreatic juice were predictive of malignant factors. How to perform the latter test effectively is a problem requiring further study.
Augmented reality in surgery is a new approach in executing detailed surgical operations. It requires low-performance surgical dexterity and is currently used as an effective teaching tool for training residents. Further, this entity may create new modes of diagnosis and treatment of technically challenging patients. Very experienced surgeons can extend the limits of a safe area to allow more complete and radical operative therapy, whereas younger surgeons may benefit by being oriented to critical anatomical landmarks.
Gauger et al, long leaders in the field of endocrine surgery, have tried to resolve the conflict of whether a gland is abnormal based on size alone, function alone, or a combination of both factors. Based on regression analysis nomograms, it was apparent from multiple timed analyses that slope was important and that the nomogram based on time-indexed intraoperative parathyroid hormone data better predicted multigland disease compared with standard arithmetic analysis. This nomogram needs to be validated prospectively.
Parviz Amid, MD, of the Lichtenstein Hernia Institute, Los Angeles, Calif, points out the problems associated with secondary operations after the preperitoneal area is violated in a hernia repair by the presence of polypropylene mesh. His suggestion is the use of composite grafts made of a layer of nonabsorbable impervious tissue membrane coupled with a layer of polypropylene mesh (Composix; Davol, Cranston, RI). This should prevent adherence of the prosthesis to iliac vessels and the prostate area during hernia repair.
Much has been written regarding volume and outcome of complex cancer procedures such as esophagectomy, hepatic resection, and pancreatic resection. In comparing teaching hospitals with similar nonteaching hospitals performing large volumes of these operations, Dimick et al found teaching hospitals had a lower operative mortality rate for these complex surgical procedures, which may be related to supervision and volume.
One of the options for successful surgical intervention in patients with breast cancer is the nipple-sparing mastectomy, which provides better cosmesis. Intraoperative pathologic assessment of the nipple core tissue and immediate reconstruction were done. Of the 54 nipple-sparing mastectomies reviewed in a 2-year period, 48 were tumor free and used in the reconstruction, thus establishing this as a reasonable option for carefully screened patients.>
This Month in Archives of Surgery. Arch Surg. 2004;139(2):127. doi:10.1001/archsurg.139.2.127