The Surgical clinics of North America
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Surg. Clin. North Am. · Oct 2010
ReviewThe compromised airway: tumors, strictures, and tracheomalacia.
Airway obstruction caused by intrinsic laryngeal and tracheal disorders requires a systematic diagnostic approach, including a careful bronchoscopic examination. Tumors of the upper airway are most often malignant; except for the larynx, metastatic lesions predominate. ⋯ Tracheomalacia related to chronic obstructive lung disease causes high-grade, chronic, long-segment airway obstruction. The surgical treatment for each group of these disorders is described.
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This review summarizes regional strategies for management of neuroendocrine liver metastases (NLM), including hepatic resection, ablation, liver transplantation, and hepatic arterial embolization/chemoembolization. Despite early disease recurrence and/or progression, resection of NLM with or without combined ablation provides long-term survival and symptom improvement. ⋯ Hepatic arterial embolization with or without local instillation of chemotherapy may induce disease response, symptomatic improvement, and prolonged survival in patients with unresectable NLM. Early disease recurrence, high postoperative mortality, the absence of extensive experience, and lack of universal indications for organ allocation preclude orthotopic liver transplantation as an option for most patients with unresectable NLM.
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Surg. Clin. North Am. · Jun 2010
ReviewFocused surgical skills training for senior medical students and interns.
Surgical skills laboratories have become an increasingly important component of technical skills training for learners entering surgical fields. This article describes the experiences with intensive skill preparation courses for senior medical students and interns. The advantages, limitations, and challenges of learning in the skills laboratory are described, and practical information is provided regarding the resources needed to carry out training for junior learners.
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Surg. Clin. North Am. · Jun 2010
ReviewFLS and FES: comprehensive models of training and assessment.
The Fundamentals of Laparoscopic surgery (FLS) is a validated program for the teaching and evaluation of the basic knowledge and skills required to perform laparoscopic surgery. The educational component includes didactic, Web-based material and a simple, affordable physical simulator with specific tasks and a recommended curriculum. FLS certification requires passing a written multiple-choice examination and a proctored manual skills examination in the FLS simulator. ⋯ It is currently in the final stages of development and will be launched in April 2010. The program also includes learning and assessment components, and is undergoing the same meticulous validation process as FLS. These programs serve as models for the creation of simulation-based tools to teach skills and assess competence with the intention of optimizing patient safety and the quality of surgical education.