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Invited Critique |

Simplifying Surgical Technique: Good for the Goose and the Gander:  Comment on “A New and Simplified Technique for Laparoscopic Gastric Bypass in a Residency Training Program”

Shirin Towfigh, MD
Arch Surg. 2010;145(9):851. doi:10.1001/archsurg.2010.164.
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Martin et al should be commended for developing a technique that simplifies one of the most advanced laparoscopic procedures performed in general surgery, that is, the laparoscopic Roux-en-Y gastric bypass. By simplifying the technique, they have not only made it so that residents can easily perform it but they have also shortened the operative time for the patient and reduced the operating room utilization cost for their institution. It seems that this is a perfect scenario.

In the past couple of decades, we have seen similar patterns in other aspects of general surgery in which simplified techniques also reduce operating time, with improved outcomes. Residents today have the luxury of applying a variety of technologies to simplify surgical technique: staplers, vessel-sealing systems, and biological glues, to name a few. As a result, we are graduating surgeons with limited experience in performing basic surgical techniques, such as hand-sewn bowel anastomosis, vessel ligation, and control of bleeding. These techniques are not necessarily of historical consequence, rather they are basic tools that we need when technology is not available or malfunctions.

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