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Invited Critique
August 18, 2008

Evaluating the Degree of Difficulty of Laparoscopic Colorectal Surgery—Invited Critique

Arch Surg. 2008;143(8):768. doi:10.1001/archsurg.143.8.768

There is nothing so easy but that it becomes difficult when you do it with reluctance.1

The notion of difficulty in surgery is an interesting one to consider. Surgeons do not, as a matter of course, think of particular types of operations as more or less hard; they are more likely to find a particular patient difficult, whether for anatomic, physiologic, or psychological reasons. It is true that some procedures are by nature more demanding than others; this usually relates to their complexity (pancreatoduodenectomy), the degree of patient risk (clipping a brain aneurysm), or the length of time of the case (en bloc esophagectomy). Still, most surgeons who may not think twice about a Whipple procedure or gastric bypass, if that is their routine practice, have experienced dread and severe stress when contemplating a hernia repair or cholecystectomy on a very frail or sick patient; or when they have found themselves in the midst of a procedure that was supposed to be minor, only to find a cascade of difficulties that make the procedure long, stressful, and excruciatingly hard.

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