RESUMEN
PURPOSE: The resident as teaching assistant (TA) in the operating room is an important role in the maturation of surgical trainees. One concern in the current 80-hour workweek era is that current senior residents (SRs) are unprepared to serve as TAs, potentially leading to higher complication rates and a significant increase in the length of operations. The aim of this study was to analyze whether SRs serving as TAs during laparoscopic cholecystectomy (LC) resulted in an adverse effect on complication rates in the 80-hour workweek era. METHODS: A retrospective review was conducted of 1668 LC performed at 2 affiliated general surgery teaching hospitals from 2003 through 2007. Teaching hospital A was a public teaching hospital where junior residents (JR) performed the LC with a scrubbed SR as TA under faculty supervision. Teaching hospital B was a community-based affiliate hospital where the JR performed LC with only scrubbed faculty supervision. Operative case duration, JR level, patient gender/age, operative indication, final pathology, and complication data were gathered and univariate and multivariate analyses were performed. RESULTS: Despite a higher rate of acute cholecystitis in the TA hospital, LC-associated complications occurred at similar rates with and without SR as TA. The rate of biliary injury was also the same in both hospitals. On multivariable analysis, only male gender was associated with complications (odds ratio = 1.7; p = 0.004). CONCLUSIONS: In the 80-hour resident workweek era, SRs acting as TAs during LC is not associated with increased total complications or an increased rate of biliary injury.
Asunto(s)
Sistema Biliar/lesiones , Colecistectomía Laparoscópica/efectos adversos , Competencia Clínica , Internado y Residencia/organización & administración , Liderazgo , Enseñanza/organización & administración , Tolerancia al Trabajo Programado , Adulto , Citas y Horarios , Colecistectomía Laparoscópica/educación , Colecistectomía Laparoscópica/métodos , Femenino , Hospitales de Enseñanza , Humanos , Incidencia , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/fisiopatología , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Medición de Riesgo , Enseñanza/métodosRESUMEN
Despite total mesorectal resection, often with accompanying chemoradiation therapy, local recurrence continues to cause significant morbidity and mortality in cases of rectal cancer. Recurrent rectal cancers are often inoperable as a result of pelvic sidewall and sacral invasion. The authors describe the use of radiofrequency (RF) ablation to manage an unresectable multiply recurrent rectal cancer in which complete ablation with durable long-term control was achieved despite the large size of the tumor. RF ablation is a viable option for patients who are poor surgical candidates or whose disease is not amenable to conventional surgical approaches.