GENERAL SURGERY NEWS The Independent Monthly Newspaper for the General Surgeon
GeneralSurgeryNews.com
January 2021 • Volume 48 • Number 1
Robotic-Assisted Hernia Repair: What Exactly Are We Arguing About?
Surgery in the Millennial Era: Staying Ahead Of the Curve
Debate Centers on Whether the Robot’s Advantages Can Be Captured By Traditional Peer-Reviewed Research
Embracing Technology, Innovation By KAREN BLUM
By CHRISTINA FRANGOU
Warren, MD, an associate professor of surgery at the University Jeremy South Carolina School of Medicine, Greenville, checks PubMed frequently
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cceptance of diversity and technology, and staying current with social media, are skills that surgeons need in the coming years, a panel of experts said during the 2020 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, which was held virtually. “Surgical training and surgical practice are very different in 2020 than decades before,” said Kate Lak, MD, FACS, an assistant professor of surgery at the Medical College of Wisconsin, in Milwaukee, and the chair of a session on surgery in the
for new reports on robotic hernia repair. Dr. Warren, a minimally invasive surgery fellowship-trained surgeon and proponent of the robot in hernia repair, has been tracking the literature on the robot for years. A search last December turned up 438 articles, with more than 100 published in the past year. That’s not a lot for a technology that has been around since the late 1990s, and one that grew in proportional use more than 40-fold for inguinal and ventral hernia repairs between 2012 and 2018 (JAMA Netw Open 2020;3[1]:e1918911). The published literature does not reflect what Dr. Warren believes the robot can do. But, he said, the evidence “is coming.” As it stands now, the state of published literature on robotic hernia repair is a hotbutton issue: Some surgeons argue that more research is necessary before this expensive Continued on page 20
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Evidence Grows for Avoiding Biopsy in Hepatocellular Carcinoma
Multimodal Laxatives Speed GI Function After Colorectal Surgery
Antibiotic Therapy For SSIs: Onus on the Surgeon to Get It Right
By KATE O’ROURKE
By CHRISTINA FRANGOU
By CHASE DOYLE
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new study supports exhausting noninvasive methods to diagnose hepatocellular carcinoma (HCC) before attempting biopsy. In an analysis of data from the National Cancer Database, overall survival was lower in HCC patients who underwent preoperative tissue diagnosis compared with clinical diagnosis. The findings were presented at the 2020 annual meeting of the Society of Surgical Oncology (abstract 63).
atients who underwent elective colorectal surgery recovered their gastrointestinal function faster when they received multimodal laxatives as part of an enhanced recovery after surgery protocol, according to a single-center, open-label, randomized controlled trial. The study, which was presented at the American College of Surgeons Clinical Congress 2020, showed no increase in overall complications or leaks associated with laxatives. The trial was designed to address the lack of evidence about readily available laxatives in improving GI function after surgery. Most published research focuses on
hen used appropriately, antibiotics decrease surgical site infections, mortality and cost while improving patient outcomes. When used inappropriately, they can increase infection risk, resistant pathogens, adverse events and mortality. It’s up to surgeons to get it right, according to Addison K. May, MD, a professor and the chief of acute care surgery at Atrium Health and Carolinas Medical Center, in Charlotte, N.C. During the American College of Surgeons Clinical Congress 2020, Dr. May shared several principles
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NE W TECHNOLOG Y
8 New Device Takes Surgical Robotics In Smaller, Simpler Direction S URGEONS’ LOU N G E
14 Operating on Older Patients J OURNAL WATCH
18 Recent Studies That Could Affect Your Practice facebook.com/generalsurgerynews
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