Critical care medicine is to provide advanced medical care to critically ill-patients threatened by severe diseases. Although critical care is a core area of surgery, surgeons have fewer interests and opportunities for participating in it, and the dedicated intensivists with other specialties have had a deeper involvement. It is difficult to recruit surgical intensivists or trauma surgeons for critical care due to the high labor intensity, high risk of medical accidents and conflicts, and inappropriate remuneration. The most common cause, however, is the lack of opportunities for surgical cases. There is a negative perception among surgeons that surgical intensivists are ‘the surgeons who do not operate.’ That makes the surgeons feel the gap between what they majored and what they practice. Acute care surgery, that is a relatively new, but more specialized surgical area including emergency surgery, trauma and critical care, can be a good alternative. Critically ill-patients who suffered from hemorrhagic shock, septic shock, acute renal injury, and acute respiratory distress syndrome need the intensive and aggressive treatments. Surgeons have been used to these invasive and aggressive procedures. Surgeons who have trained the critical care may be able to acquire the expertise, easily. The intensivists as a surgeon, who fully understands the operations, postoperative courses or complications, or the optimal time of surgery, can provide more efficient and accurate treatments for surgically critically ill-patients than any intensivists with other specialties. It is needed to change the surgeons' negative perceptions themselves with the support of the Korean Society of Surgery.
Citations
, Bo-Young Oh, Ryung-Ah Lee , Kyoung Tae Noh, Boyoung Oh, Ryung-Ah Lee, Soon-Sup Chung, Kwang Ho Kim Hand-assisted laparoscopic surgery had both technical advantages of open surgery and better postoperative short-term follow-up results of laparoscopic surgery. We compared open colectomy, laparoscopic colectomy and hand-assisted laparoscopic colectomy, and tried to find the most effective operative modality.
90 patients, who were diagnosed with colorectal cancer and underwent colectomy in our institution, were categorized as 3 groups of open colectomy (OC) group, laparoscopic colectomy (LC) group and hand-assisted laparoscopic colectomy (HALC) group by the surgical modality.
In this study, ratio of male and female was 57 : 37, and mean age was 64.1 years old. LC group and HALC group showed longer operation time, shorter hospital stay after operation, lesser pain and earlier removal of closed drainage catheter than OC group. Amount of bleeding during operation, frequency of transfusion and incidence of complication showed no significant difference. In permanent pathologic results, the number of harvested lymph nodes had significant difference between OC group and other groups (P=0.030), but it was probably caused by the bias of the different distribution of the stages in each group. Overall 14 of the cases resulted in complications while there was no mortality.
Laparoscopic colectomy and hand-assisted laparoscopic colectomy showed better short-term follow-up results rather than open colectomy. And hand-assisted laparoscopic surgery could provide tactile sensation to operator, which lacked in laparoscopic surgery. Hand-assisted laparoscopic colectomy could be an alternative surgical option for colorectal cancer with these advantages.
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