ANZ journal of surgery
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ANZ journal of surgery · Apr 2008
Review Comparative StudySurgical management of carcinoma of the head of pancreas: extended lymphadenectomy or modified en bloc resection?
Pancreatoduodenectomy for the treatment of periampullary cancer was described over 70 years ago. The technique has evolved in an attempt to improve the dismal prognosis for patients with pancreatic cancers. Radical regional resection has been proposed to decrease the incidence of local recurrence as well as to improve survival. ⋯ This procedure is a modification of the radical regional resection previously described. It involves resection of the peripancreatic retroperitoneal tissue and lymph nodes en bloc with the head of pancreas, in order to achieve an R0 resection but without the morbidity associated with an extended lymphadenectomy. Conceptually, this procedure may be the most appropriate technique for the management of pancreatic head cancers although the ultimate effect on long-term survival can only be judged after further clinical studies.
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ANZ journal of surgery · Apr 2008
Multicenter Study Clinical TrialPancreatoduodenectomy: role of drain fluid analysis in the management of pancreatic fistula.
Pancreatic fistula remains an important cause of death following pancreatoduodenectomy. There is still uncertainty regarding the use of drains following pancreatoduodenectomy with recent reports suggesting that it might be harmful with increased complications. We evaluated the use of drain fluid analysis in the management of patients following pancreatoduodenectomy. ⋯ The drain fluid analysis did not provide additional information that was not already evident from the clinical picture of the patient. Drain fluid analysis had no effect on patients with a biochemical leak only. Patients who had a significant disruption of their pancreatic anastamosis did not need biochemical analysis as the character, that is, turbidity of the drain fluid was an equally reliable indicator of the underlying pathology.
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ANZ journal of surgery · Apr 2008
Clinical impact of oncoplastic surgery in a specialist breast practice.
Oncoplastic breast surgery is an integral and fundamental component of the clinical management of breast cancer. The aim of this study was to determine the proportion of oncoplastic and reconstructive breast cancer procedures undertaken within a specialist breast practice. ⋯ Specialist breast surgeons trained in breast reconstruction and oncoplastic techniques can expect a substantial proportion of their breast practice to include such operative procedures (28% in this series). Subspecialist training in breast surgery should incorporate experience in breast reconstructive and aesthetic surgery for trainees who wish to practise as specialist breast surgeons in the future.
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ANZ journal of surgery · Apr 2008
Novel method for assessment and selection of trainees for higher surgical training in general surgery.
The aim of the study was to select surgeons for a higher surgical training in general surgery programme at the Royal College of Surgeons in Ireland (RCSI) using an objective, transparent and fair assessment programme. Thirty-two individuals applied for higher surgical training in general surgery in Ireland in 2006. Sixteen applicants were short-listed for interview and further assessment. ⋯ The objective assessment programme introduced by RCSI for selection of candidates for the programme in higher surgical training in general surgery reliably and consistently distinguished between candidates. Candidates selected for further training consistently outperformed those who were not in good concordance between measures. This common selection process for higher surgical training is now being rolled out for selection into higher surgical training across all surgical specialties in Ireland.
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ANZ journal of surgery · Apr 2008
Assessment of laparoscopic psychomotor skills in interns using the MIST Virtual Reality Simulator: a prerequisite for those considering surgical training?
Selection for surgical training in Australia is currently based on assessment of a structured curriculum vitae, referral reports from selected clinicians and an interview. The formal assessment of laparoscopic psychomotor skill and ability to attain skills is not currently a prerequisite for selection. The aim of this study was to assess the innate psychomotor skills of interns and also to compare interns with an interest in pursuing a surgical career to interns with those with no interest in pursuing a surgical career. ⋯ Interns with and without inherent abilities have aspirations to pursue surgical careers and their aptitude does not seem to influence this decision. Surgical colleges could use psychomotor ability assessments to recruit candidates to pursue a career in surgery. Trainees needing closer monitoring and additional training could be identified early and guided to achieve competency.