Abstract:
:It is a fact that without ideas there is nothing. Without ideas and without innovations there is nothing to test. An interesting, often asked question is: How are ideas, innovations born? It is surely correct that people giving birth to ideas have special characteristics. These creative people are different but still have many, maybe essential, characteristics in common. They are open-minded. Abnormality is interesting for them. They are highly emotional, passionate. They are intelligent and naive at the same time. They are often like children but they also are determined and enjoy their lives. It is a fact that an idea, once born, does not always attain fruition; place, time, social environment, and society have to fit. The domain has to be prepared for it. The true pioneer is the one who has seen the beginning to a certain degree but also brings the new idea to the public, places it on the agenda, accompanies it with positive skepticism, and most of all carries it over the "finishing line." Giving birth to an idea is an important step. Testing the idea regarding its effectivity is a necessity. Since Decartes, in our Western way of thinking, we have a systematic methodic procedure. The idea is expressed in a hypothesis. Here the hypothesis is: "Endoscopic surgery supplies more comfort and means less trauma at the same or greater safety." This is the idea, the dream, the hypothesis. In concrete terms it means less pestering, less pain, less fatigue, and in general a quicker return to daily life during the pre- and postoperative course. Less trauma means less stress response of the body; these are the true endpoints. In the long run, endoscopic surgery means-this being the unproved prerequisite-physical integrity, less immunosuppression, and last but not least consideration of the abdominal wall (in concrete terms, fewer incisional hernias). Thus the relevant endpoints have been formulated by the concrete terms of the hypothesis. This makes clear that comfort relates to-and this is for the first time-"soft" data. This is the true revolution. For me this is a true change of paradigm. Here a few important problems become evident. In the first place, a solution must be found-with the intention of reality and coolness-for the problem of comparing "soft" and "hard" data. With this problem it must be clear that subjective endpoints strongly depend on social and cultural circumstances and are probably influenced more by these factors than by the endoscopic surgery itself. The placebo effect must also be considered. Up to 50% of the subjective endpoints are due to the placebo effect, especially with surgery. For example, pain and return to work depend heavily on socioeconomic aspects and the placebo effect. In summary, the first step is the idea; the second step is testing the idea for effectiveness. Endoscopic surgery as a patient-friendly treatment is the idea, the hypothesis. This hypothesis must be tested according to our present standard of methodology. In addition to the "conventional" endpoints (negative events), the comfort of the patient is the true endpoint of patient-friendly surgery-endoscopic surgery.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Troidl Hdoi
10.1007/s002689900577keywords:
subject
Has Abstractpub_date
1999-08-01 00:00:00pages
754-67issue
8eissn
0364-2313issn
1432-2323pii
5290journal_volume
23pub_type
历史文章,杂志文章abstract:BACKGROUND:The aim of this study was to report on the application of a minimally invasive technique to the radical extirpation of primary and recurrent pilonidal disease. This technique does not require specific equipments, is ordinarily performed under local anesthesia on an outpatient basis, and provides optimal cosm...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-019-05313-3
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:The Severe Acute Respiratory Syndrome Coronavirus 2 pandemic has exposed surgeons to hazardous working conditions, imposing the need for personal protective equipment (PPE) use during surgery. The use of such equipment may affect their non-technical skills, augment fatigue, and affect performance. This study...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05648-2
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Inflammation is integral to the pathogenesis of abdominal aortic aneurysm (AAA). This study examines preoperative biomarkers of systemic inflammation in patients undergoing open repair of intact and ruptured AAA. METHODS:One-hundred twelve patients were entered into a prospective observational study. Preope...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-007-9014-6
更新日期:2007-06-01 00:00:00
abstract::The phrase "outcomes studies" is usually used to describe those studies where outcome is assessed in large cohorts of patients, often using data from administrative databases. They are used to determine the role and impact of variations in the structure and process of health care delivery play in routine practice. Opt...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s002689900651
更新日期:1999-12-01 00:00:00
abstract:BACKGROUND:Although the low central venous pressure (LCVP) technique is used to decrease blood loss during liver resection, its efficacy and safety during transplant procedures are still debatable. Our study aimed to assess the effects of this technique and its clinical safety for recipients undergoing liver transplant...
journal_title:World journal of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00268-010-0544-y
更新日期:2010-08-01 00:00:00
abstract:BACKGROUND:Acute appendicitis is the most common reason for abdominal surgery in young adults and children. Open appendectomy is still the treatment often chosen because it is simple, safe, and effective. Our aim was to study whether cosmetic results of appendectomy wounds are better after using continuous absorbable i...
journal_title:World journal of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00268-013-2396-8
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND:Gastroesophageal reflux is the main risk factor for esophageal adenocarcinoma, but there is no strong support for a protective effect of antireflux surgery. We tested the hypothesis that esophageal adenocarcinoma that develops with long latency after antireflux surgery might be due to persistent postoperativ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-006-0386-9
更新日期:2007-03-01 00:00:00
abstract::Resection remains the treatment of choice in liver cancer. In order to avoid liver transplantation in conventionally unresectable tumors ex-situ ("bench" procedure), in-situ and ante-situm resection technique should be preferred whenever feasible. Despite the deficiency of donor organs, a single center experience with...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF00299775
更新日期:1995-11-01 00:00:00
abstract::A new technique utilizing miniaturized (2 mm) instrumentation to perform laparoscopic cholecystectomy (LC) is introduced. The safety and efficacy of this mini-LC were assessed. Fifty consecutive mini-LCs were performed using one 10-mm port and three 2-mm ports (cumulative port size 16 mm). A 2-mm fiberoptic video-lapa...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/pl00013163
更新日期:1999-02-01 00:00:00
abstract:BACKGROUND:Delayed recovery of gastrointestinal (GI) motility is a common complication following surgery. TZP-101/ulimorelin is a macrocyclic peptidomimetic ghrelin receptor agonist with GI promotility effects that significantly accelerates time to recovery of GI motility compared to placebo following partial colectomy...
journal_title:World journal of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s00268-011-1335-9
更新日期:2012-01-01 00:00:00
abstract::The effects of splenectomy in 41 patients managed from 1982 to 1995 at Sher-i-Kashmir Institute of Medical Sciences, Srinagar (Jammu and Kashmir), India, were studied. Immune thrombocytopenic purpura (ITP) was the main indication for therapeutic splenectomy among all the hematologic disorders. The mean age was 30 year...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002689910017
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Trauma in the elderly (≥ 55 years) accounts for a significant proportion of admissions to trauma centers. Our understanding of the epidemiology and outcomes associated with penetrating injury in this age segment of the population, however, is severely limited. The aim of the present study therefore was to in...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0920-7
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:Awake tracheostomy (AT) is aimed at securing the airway of patients with upper airway obstruction when other means are not feasible or have failed. Reports on AT in the literature are scarce. The goal of this study was to review our experience with the indications, complications and outcome of AT. METHODS:A...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-018-4578-x
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:Peritoneal adhesions are recognized as an important cause for patient morbidity, but complications related to adhesions occur relatively late after the original operation. Therefore preoperative consent may not adequately reflect the proportions of the problem. METHODS:A total of 200 patients admitted for i...
journal_title:World journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1007/s00268-008-9917-x
更新日期:2009-04-01 00:00:00
abstract::From the earliest description of dysphagia relieved by dilatation with a whalebone in 1674 we have witnessed the evolution of esophageal function testing from the conventional manometry to the high-resolution manometry (HRM) and esophageal topography pressure plotting that have led to the revised Chicago classificatio...
journal_title:World journal of surgery
pub_type: 历史文章,杂志文章
doi:10.1007/s00268-014-2939-7
更新日期:2015-07-01 00:00:00
abstract::The pylorus-preserving pancreaticoduodenectomy (PPPD) is an alternative to the standard Whipple resection in the treatment of chronic pancreatitis. The operation is safe and can be performed with a low mortality rate. The most common early complication is delayed gastric emptying, which occurs in 25% to 30% of patient...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s00268-003-7240-0
更新日期:2003-11-01 00:00:00
abstract:BACKGROUND:The aim of this study was to determine if intrabiliary rupture (IBR), an evolutive complication of hepatic echinococcosis (HE), is a risk factor for developing postoperative morbidity (POM). METHODS:This was a concurrent cohort study that included patients operated on for HE between 1996 and 2006 and who ha...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0322-x
更新日期:2010-03-01 00:00:00
abstract::Whether for hepatic trauma or transplantation, a surgeon's knowledge of hepatic anatomy commonly determines a patient's outcome. The first medically relevant anatomic studies of the liver emerged with the endeavors of Herophilus and Erasistratus between 310 and 280 bc. Yet it was not until after the development of ane...
journal_title:World journal of surgery
pub_type: 传,历史文章,杂志文章
doi:10.1007/s002689900238
更新日期:1997-03-01 00:00:00
abstract::Upper dorsal sympathectomy is the only successful therapeutic method for idiopathic palmar hyperhidrosis (IPHH). However, the techniques for sympathetic ablation are still debated. The aim of this study was to compare prospectively two accepted methods for endoscopic sympathetic ablation: resection of T2-T3 ganglia ve...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-007-9160-x
更新日期:2007-10-01 00:00:00
abstract:BACKGROUND:The purpose of the present study was twofold: to summarize the characteristics of trauma patients with thoracic injury in the 2008 earthquake of Wenchuan, Sichuan, China, and to validate the accuracy of the Injury Severity Score (ISS), the New Injury Severity Score (NISS), and the Chest Injury Index (CII) in...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0427-2
更新日期:2010-04-01 00:00:00
abstract:BACKGROUND:The aim of the present study was to evaluate the influence of donor age on liver regeneration and surgical outcomes in recipients and donors. PATIENTS AND METHODS:Among 101 cases of adult-to-adult living donor liver transplantation (LDLT) between March 2002 and March 2011, according to donor age: younger (Y...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-012-1496-1
更新日期:2012-05-01 00:00:00
abstract::Uncontrolled bleeding from the cystic artery and its branches is a serious problem that may increase the risk of intraoperative lesions to vital vascular and biliary structures. On laparoscopic visualization anatomic relations are seen differently than during conventional surgery, so proper knowledge of the hepatobili...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/pl00012372
更新日期:1999-07-01 00:00:00
abstract::Surgery is the most effective therapeutic intervention available for the treatment of breast cancer. It has been responsible for obtaining local control and long-term disease-free intervals in more patients over the past century than any other treatment modality. Trends toward earlier stage at diagnosis are likely to ...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s00268-001-0010-y
更新日期:2001-06-01 00:00:00
abstract::Fingertip injuries constitute a large portion of the traumatic injuries sustained to the hand and are frequently associated with significant disability for the patient. While many methods are available for the treatment of such injuries, quite often only certain procedures are appropriate for a particular digit in any...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF01675641
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND:Currently, there are no objective reports evaluating the quality of the South African surgical training. The aim of this study is to evaluate the current state of surgical training in South Africa from an external impartial point of view and to rate the experience of short-term supernumerary registrars and f...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-019-05034-7
更新日期:2019-09-01 00:00:00
abstract::To illustrate how the high incidence of arrow wounds provided a major stimulus for the development of surgery until a century ago, we conducted a literature search. Our research shows that archaic peoples developed considerable surgical skill for extraction of arrows, including thoracotomy and trephination. A classica...
journal_title:World journal of surgery
pub_type: 历史文章,杂志文章
doi:10.1007/s00268-001-0168-3
更新日期:2001-12-01 00:00:00
abstract:BACKGROUND:Sometimes, it seems to be difficult to preserve the aberrant hepatic artery (HA) during pancreaticoduodenectomy (PD), with respect to en bloc lymph node dissection, especially in the case of aberrant right hepatic artery (RHA). Therefore, we evaluated the influence of incomplete en bloc lymph node (LN) disse...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0063-x
更新日期:2009-08-01 00:00:00
abstract::Chondrosarcomas of the head and neck are uncommon. Over a 35-year period (1950-1985) at our institution, 557 patients had an established diagnosis of chondrosarcoma. In 28 (5%) of these patients, the tumor was located in the head and neck region. A retrospective analysis was performed in an attempt to accurately defin...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF02067021
更新日期:1992-09-01 00:00:00
abstract::The lack of sufficient suitable human donor lungs for the many patients requiring pulmonary transplantation as life-saving therapy for end-stage lung diseases has generated extensive interest in cross-species lung transplantation. Ethical concerns and those of animal rights advocates have prompted studies of nonprimat...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s002689900332
更新日期:1997-11-01 00:00:00
abstract:INTRODUCTION:This study assesses the incidence of missed pelvic injuries in the pre-hospital setting. METHODS:All blunt trauma patients (ISS ≥ 9) with pre-hospital suspicion of and/or radiologically proven pelvic fracture documented in the TraumaRegister DGU® (TR-DGU) of the German Trauma Society DGU (2002-2011) were ...
journal_title:World journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1007/s00268-016-3647-2
更新日期:2016-12-01 00:00:00