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We are in the midst of a laparoscopy explosion in general surgery. Two articles relate to some problem areas of this technique. The first, by Berguer and colleagues, is an ergonomic study of the labor or physical effort required for laparoscopic maneuvering as opposed to an open procedure in the art of knot tying. They concluded that complex manipulative tasks using laparoscopic instrumentation require substantially higher upper extremity muscle effort compared with open surgery. This increased workload is often accompanied by an increase in the subjective discomfort of the surgeon in the affected areas—food for thought.
Second, Podnos and colleagues have reviewed the literature regarding the complications after laparoscopic gastric bypass (3464 cases). They found that the type and frequency of postoperative complications after laparoscopic and open gastric bypass are different. Laparoscopic operations were associated with a higher frequency of early and late bowel obstruction, gastrointestinal hemorrhage, and stomal stenosis, whereas the open bypass was plagued by iatrogenic splenectomy, wound infection, incisional hernia, and mortality. The authors believe that part of the difference regarding laparoscopy is related to the learning curve of this complex procedure. This article provides an interesting analysis.
This Month in Archives of Surgery. Arch Surg. 2003;138(9):939. doi:10.1001/archsurg.138.9.939
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