The Role of Pathology in Diagnosis and Surgical Decision-Making1

2015 ◽  
pp. 80-92 ◽  
Author(s):  
L. Grimelius ◽  
G. �kerstr�m ◽  
H. Johansson ◽  
S. Ljunghall ◽  
J. Rastad
Keyword(s):  
Surgical Decision

Is surgery more about doing than thinking?

2019 ◽  
Vol 80 (10) ◽  
pp. 605-608
Author(s):  
Soumya Mukherjee ◽  
James Meacock ◽  
Paul Chumas
Keyword(s):  
Complex Analysis ◽  
Medical Literature ◽  
Adaptive Expertise ◽  
Surgical Decision ◽  
Strategic Approach ◽  
Trained Staff ◽  
Personal Reflections ◽  
Surgical Decision Making ◽  
And Training

Detailed thought, knowledge, complex analysis, reasoned judgment and professionalism all fundamentally underpin a surgeon's work and training, yet there is a popularly held view that accomplished surgeons are primarily concerned with performing procedures. A review of pedagogical, social and medical literature, together with personal reflections from the authors, shows that a surgeon's work is multi-faceted. This article discusses the technical skills of operating as a reflection of the ‘tip of the iceberg’ of a surgeon's cognition, the increasingly multidisciplinary strategic approach of surgeons today, the importance of surgical decision making, the influence of robotics, the role of non-medically trained staff, surgeons' role in postoperative care, adaptive expertise and the formation of professional identity. In so doing, a much wider view of a surgeon than simply ‘doing’ or ‘thinking’ is presented with implications for surgical training.

Role of intraoperative enteroscopy for surgical decision making with Crohn’s disease

2007 ◽  
Vol 21 (7) ◽  
pp. 1238-1242 ◽  
Author(s):  
M. Hotokezaka ◽  
S-I. Jimi ◽  
H. Hidaka ◽  
N. Maehara ◽  
T-A. Eto ◽  
...  
Keyword(s):  
Decision Making ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Surgical Decision ◽  
Intraoperative Enteroscopy ◽  
Surgical Decision Making

scholarly journals The Role Of Rose (Rapid Onsite Evaluation) On Spinal Lesion Surgery Decision

2019 ◽  
Vol 5 (1) ◽  
pp. 66-73
Author(s):  
Sindrawati ◽  
Komang Agung ◽  
Carlos Binti ◽  
Anggita Dewi Dewi
Keyword(s):  
Surgical Techniques ◽  
Host Population ◽  
Pathological Fractures ◽  
Surgical Decision ◽  
Best Management ◽  
Normal Host ◽  
Spinal Lesion ◽  
Lytic Lesions ◽  
Histopathology Result

Introduction: Exposure and instrumentation of the spine must be meticulous and thorough regardless the techniques and approach selected. Management of the whole surgery process should be decided based on the best available evidence whenever possible. ROSE (Rapid Onsite Evaluation) cytology wrap up the surgical decision. Case Description: Fifteen cases comprise of lytic lesions and/or single pathological fractures of the corpus vertebrae will be presented and discuss as to how the surgical techniques and approaches are assisted by ROSE. ROSE cytology was performed in the operating theater during the surgery. Samples were taken after exposure of the minimal lesion using (18–21) G trocar needle or under fluoroscopy guided. Direct smear, air dried fixation, and Diff Quik staining would take about 10 minutes. Pathologist evaluated the specimen and provided the result in about 20 minutes. The overall 30 minutes allowed surgeon to prepare the further steps. Results would be malignant or benign without pursuing further detail diagnostic. Benign results should be categorized as infection, suspicious of granulomatic tuberculosis, or normal host population cells. The cases outcome were 8 normal host population cells advanced for vertebroplasty to fill the porotic bone. Three spondylitis tuberculosis were debrided without unnecessary instrumentation, and four malignant processes were assured to have enough samples for immunohistochemistry evaluation afterward. All ROSE cytology was confirmed accordingly by the histopathology result afterward. Conclusion: ROSE is easy and offers accurate sampling from the lesion itself. It is quick, therefore during surgery surgeon could decide the best management for the patient.

Role of Invasive Monitoring in Surgical Decision Making in Epilepsy Surgery

Neurosurgery ◽  
1999 ◽  
Vol 45 (3) ◽  
pp. 699-699
Author(s):  
Milind Deogaonkar ◽  
Martin Weinand ◽  
David Labiner
Keyword(s):  
Decision Making ◽  
Epilepsy Surgery ◽  
Invasive Monitoring ◽  
Surgical Decision ◽  
Surgical Decision Making

Validation of an Online Calculator to Predict Short-term Postoperative Outcomes in Patients with Metastatic Brain Tumors

2021 ◽  
Author(s):  
Jennifer H. Kang ◽  
Kelly Ryan Murphy ◽  
Edwin McCray ◽  
Luis Ramirez ◽  
Meghan Price ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Frailty Index ◽  
Roc Curves ◽  
Operating Characteristics ◽  
Surgical Decision ◽  
Discharge Disposition ◽  
Admission Status ◽  
Modified Frailty Index ◽  
Online Calculator

Abstract Introduction: Estimating the risk of extended length of stay (LOS) or non-routine discharge disposition is helpful in surgical decision-making for patients with brain metastases (BM). In 2020, an online calculator was introduced by Khalafallah et al. that stratified the risk of patients with brain tumors based on poor surgical outcomes. We applied the calculator to our population of BM patients to determine its generalizability and validity. Methods: We included BM patients who underwent a cranial procedure between 2015 and 2018 at a single academic institution. Patient age, race, marital status, admission status, KPS score, and medical co-morbidities (5-point modified frailty index (mFI-5)) were included in the analysis. We calculated the areas under the Receiver Operating Characteristics (ROC) curves to determine the validity of the model proposed in predicting extended LOS (>7 days) and need for specialty care at discharge (non-routine discharge disposition). Results: We analyzed 244 patients (mean age 61.2 years (SD 11.1), 57.0% female, and 78.1% Caucasian). The areas under the ROC curves were 0.8427 and 0.8422 for extended LOS and non-routine discharge disposition, suggesting high accuracy of the models for these outcomes. However, the (mFI-5) was not a significant predictor of either outcome in our multivariate analyses. Conclusions: We validated Khalafallah et al.’s predictive models of extended LOS and non-routine discharge disposition in our patient population, which included a broader range of surgical procedures. Further investigation of this model could clarify how the type of neurosurgical procedure influences outcomes, the role of the mFI-5, and its overall generalizability.

scholarly journals The importance of curve severity, type and instrumentation strategy in the surgical correction of adolescent idiopathic scoliosis: an in silico clinical trial on 64 cases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Fabio Galbusera ◽  
Andrea Cina ◽  
Matteo Panico ◽  
Tito Bassani
Keyword(s):  
Clinical Trial ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
In Silico ◽  
Three Dimensional ◽  
Clinical Results ◽  
Implant Loosening ◽  
Surgical Decision ◽  
Curve Severity

AbstractAdolescent idiopathic scoliosis is a three-dimensional deformity of the spine which is frequently corrected with the implantation of instrumentation with generally good or excellent clinical results; mechanical post-operative complications such as implant loosening and breakage are however relatively frequent. The rate of complications is associated with a lack of consensus about the surgical decision-making process; choices about the instrumentation length, the anchoring implants and the degree of correction are indeed mostly based on personal views and previous experience of the surgeon. In this work, we performed an in silico clinical trial on a large number of subjects in order to clarify which factors have the highest importance in determining the risk of complications by quantitatively analysing the mechanical stresses and loads in the instrumentation after the correction maneuvers. The results of the simulations highlighted the fundamental role of the curve severity, also in its three-dimensional aspect, and of the instrumentation strategy, whereas the length of the fixation had a lower importance.

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