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  • Safety for the Surgical Patient—What Will “Move the Needle?”: The 2016 National Surgical Patient Safety Summit

    Abstract Full Text
    JAMA Surg. 2017; 152(7):615-616. doi: 10.1001/jamasurg.2017.0503

    This Viewpoint argues for adopting several surgical safety and learning standards proposed by participants in the 2016 National Surgical Patient Safety Summit.

  • Minimizing Shear and Compressive Stress During Pancreaticojejunostomy: Rationale of a New Technical Modification

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    JAMA Surg. 2014; 149(2):203-207. doi: 10.1001/jamasurg.2013.2256

    Neychev and Salinger elucidate the mechanics of needle-pancreas interaction and make adjustments to their pancreaticojejunostomy technique with the purpose of minimizing shear and compressive stress.

  • JAMA Surgery February 1, 2014

    Figure 1: Schematic of Outer-Row Pancreaticojejunal Anastomosis

    A, Full-thickness outer-row U sutures with the needle straightened by the surgeon. B, The force (Fτ) applied by the surgeon at an application point (A) with its shear (Ft) and compressive (Fr) components, the center of the needle (C), the shear and compressive forces inversely proportional to the radius of the needle (r), and the angle (θ) between the radius and force vectors are depicted. C, The same section depicts the needle straightened with a bigger radius (r) and application angle (θ) and less shear (Ft) and compressive (Fr) forces. Calculations are given in the Supplement (eAppendix).
  • JAMA Surgery February 1, 2014

    Figure 3: Schematic of Tying Outer-Row Sutures

    A, The double-armed sutures tied on the jejunum. B, The shear (horizontal) component (Fh) of the force (Fs) created during double-armed suture tying redirected from the pancreas to the bowel wall. Fv indicates the nonshear (vertical) component. C, Single-needle suture technique not allowing for complete redistribution of shear component (Fh) to the forces (Fs) from the pancreas to the bowel. D, Tying sutures on the anterior surface of the pancreas before placing them through the jejunum changes the direction of the force vectors from vertical (Fv) to horizontal (Fh) and results in redistributing the shear forces (Fs) from the bowel back to the pancreas. Calculations are given in the Supplement (eAppendix).
  • Preoperative Biopsy Evaluation of Chemotherapy-Associated Liver Injuries: Looking for a Needle in a Haystack? Comment on “Prospective Evaluation of Accuracy of Liver Biopsy Findings in the Identification of Chemotherapy-Associated Liver Injury”

    Abstract Full Text
    Arch Surg. 2012; 147(12):1092-1092. doi: 10.1001/archsurg.2012.1874
  • The Death of Another Sacred Cow: Comment on “Radiologic Evaluation of Alternative Sites for Needle Decompression of Tension Pneumothorax”

    Abstract Full Text
    Arch Surg. 2012; 147(9):818-819. doi: 10.1001/archsurg.2012.759
  • Radiologic Evaluation of Alternative Sites for Needle Decompression of Tension Pneumothorax

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    Arch Surg. 2012; 147(9):813-818. doi: 10.1001/archsurg.2012.751
    Inaba and coauthors conducted a retrospective study on patients with chest trauma, divided into quartiles by body mass index, to compare the distance to be traversed during needle decompression between the second intercostal space and midclavicular line with the fifth intercostal space in the anterior axillary line. In a related commentary, Schreiber discusses the need for such research.
  • Image of the Month—Quiz Case

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    Arch Surg. 2012; 147(1):93-93. doi: 10.1001/archsurg.2011.702a
  • Image of the Month—Quiz Case

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    Arch Surg. 2010; 145(6):597-597. doi: 10.1001/archsurg.2010.90-a
  • Image of the Month—Diagnosis

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    Arch Surg. 2010; 145(6):598-598. doi: 10.1001/archsurg.2010.90-b
  • Effect of Stitch Length on Complications

    Abstract Full Text
    Arch Surg. 2010; 145(6):600-600. doi: 10.1001/archsurg.2010.95
  • JAMA Surgery October 1, 2009

    Figure 2: Transumbilical Laparoscopic Cholecystectomy: A Novel Technique

    Prolene loop through 20-gauge spinal needle used to pull ends of silk suture through the abdominal wall.
  • Image of the Month—Quiz Case

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    Arch Surg. 2008; 143(8):805-805. doi: 10.1001/archsurg.143.8.805
  • JAMA Surgery April 1, 2008

    Figure 1: Liver Resection With a New Multiprobe Bipolar Radiofrequency Device

    The Habib 4X multiprobe bipolar radiofrequency device (RITA Medical Systems Inc, Freemont, California), a handheld electrosurgical instrument consisting of a 2 × 2 array of 4 needles spaced at the corners of a 6 × 7-mm rectangle. There are 2 versions: 1 with long (120-mm) needles (left) and 1 with short (60-mm) needles (right).
  • JAMA Surgery December 1, 2005

    Figure: Transanal Endoscopic Repair of Rectal Anastomotic Defect

    Technique of transanal endoscopic repair. A laparoscopic needle driver is placed through a 10-cm proctoscope to the site of anastomotic disruption. A, The suture is passed from inside to outside through the inferior portion of the disrupted anastomosis. B, The suture is passed from outside to inside through the superior portion of the disrupted anastomosis. C, The suture is tied, and several other similar sutures are placed. Note that there is no attempt to perform an airtight repair.
  • JAMA Surgery February 1, 2005

    Figure 1: Applicability of Tissue Aspirate for Quick Parathyroid Hormone Assay to Confirm Parathyroid Tissue Identity During Parathyroidectomy for Primary Hyperparathyroidism

    A 23-gauge needle connected to a 2.5-mL syringe was punctured into the suspected parathyroid adenoma. It was then moved back and forth to aspirate its content into the needle (arrow), which was then rinsed with a 2-mL aliquot of saline solution.
  • JAMA Surgery November 1, 2004

    Figure 2: 1% Lymphazurin vs 10% Fluorescein for Sentinel Node Mapping in Colorectal Tumors

    Injection of 10% fluorescein into the subserosal layer surrounding the tumor using a tuberculin syringe and a 30-gauge needle.
  • JAMA Surgery October 1, 2004

    Figure 16: From the Lumen to the Laparoscope

    Janos Veress (top left), a Hungarian physician, described a needle in 1938 (right) that was designed by him to prevent damage to the lungs or abdominal organs, either during removal of fluid from the thoracic or peritoneal cavity or during treatment of pneumothorax. The blunt-tipped cannula was connected to a spring and was slightly longer than the sharply pointed external needle (bottom). The cannula was held back by the skin and other solid tissue during insertion until the tip of the needle penetrated the pleura or peritoneum. The blunt end of the spring-loaded cannula then advanced automatically with, supposedly, no danger to internal organs. Veress successfully used this needle in more than 2000 procedures and concluded his original manuscript with the note that the instrument was beneficial to the healing process and that the smallest of injuries to lung tissue was preventable.
  • JAMA Surgery October 1, 2004

    Figure 13: From the Lumen to the Laparoscope

    Georg Kelling of Dresden, Germany (top right), was the man who most effectively demonstrated the clinical applicability of laparoscopy. In 1901, at the 73rd German Naturalists and Physicians meeting, Kelling demonstrated its use on a live dog by inserting a Nitze cystoscope into the peritoneal cavity and demonstrating the pristine condition of the abdominal viscera. Although Kelling referred to his technique as coelioscopy in his January 1902 publication (top), it would subsequently be variously recognized as organoscopy or peritoneoscopy. By 1910, Kelling had devised a safe technique for inducing pneumoperitoneum, had produced modified instruments (center), and had successfully examined a series of humans. In the same year, Hans Christen Jacobaeus of Stockholm, Sweden (bottom left), published 2 cases of visceral exploration, one thoracic and one abdominal, and designated his technique as thoracolaparoscopy (Uber Laparo und Thorakoskopie) (bottom). The methods he used were less advanced than those of Kelling, who had described a separate needle with filtered air to produce the pneumoperitoneum, preferring to use the trocar for this purpose. Although Jacobaeus reported on 115 laparoscopies in 1912 and described cirrhosis, metastatic disease, and tuberculous peritonitis, he thereafter abandoned the procedure and devoted his attention to thorascopic lysis of tuberculous lung lesions. The logic of the latter procedure proposed that lysis would permit complete lung collapse after artificial pneumothorax induction and thereby would ensure healing.
  • JAMA Surgery August 1, 2004

    Figure 3: Use of Preoperative Breast Ultrasonography for Mapping of Breast Cancer Extent Improves Resection Margins During Breast Conservation Surgery

    Comparison of margins of tumor resection. Group 1 indicates 61 patients with breast cancer in whom palpation or needle-wire–guided breast conservation surgery was used; group 2, 61 patients with breast cancer in whom preoperative breast ultrasonography was added to the protocol.