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March 16, 2009

Image Is Everything

Arch Surg. 2009;144(3):206. doi:10.1001/archsurg.2008.546

One of the most amazing advances in the clinical treatment and management of disease is the ability to detect so many things preoperatively using imaging technologies such as 3-dimensional computed tomography, magnetic resonance imaging, or positron emission tomography. Metastatic disease, anatomic variants, and involvement of blood vessels in a neoplastic or inflammatory process are now routinely seen on preoperative images and substantiated by surgical exploration. Rarely are we “surprised.” The procedure we have routinely called exploratory laparotomy is now mainly performed for confirmation and treatment, not for discovery. Video projections of laparoscopic procedures are now available, and, most recently, I have used a high-resolution camera mounted on a loupe to project a view of the operative field to all in the room—observers, students, nurses, technicians, and the anesthesia team. I foresee, as many do, even more reliance on images in real-time as we continue operating like neurosurgeons and orthopedic surgeons do already.

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