Faculty Bibliography

PURPOSE: Because most surgery patients now recover at home rather than in the hospital, we wanted to determine whether postoperative home visits by the operating surgeon would improve medical outcomes, and whether this innovation would strengthen resident training. METHODS: A surgeon who had performed 347 procedures during a 7-month period attempted to do a home visit to each patient within 48 hours after surgery. RESULTS: Many patients had to be disqualified for various reasons, leaving 143 candidates. Of these, 44 declined to be seen, and others could not be located, so that 82 were actually visited. There were no readmissions, and no findings that might have altered the course of postoperative treatment. CONCLUSIONS: These visits seemed to reinforce patient-physician relationships, but they did not influence medical outcomes. It was felt that a phone call would probably have done as well. In addition, because of new regulations governing resident working hours, it did not appear that this was a feasible educational experience.

OBJECTIVE: As surgeons become more experienced with basic laparoscopic procedures like cholecystectomy, they are able to expand this approach to less common operations. However, without laparoscopic suturing skills, like those obtained with Nissen fundoplication, many operations cannot be completed laparoscopically. We present a series of 10 patients with less common surgical illnesses who were successfully treated with minimal access techniques and intracorporeal suturing. METHODS: Over a 6-month period at 2 medical centers, 10 patients underwent operations with laparoscopic intracorporeal suturing and knot tying. Diagnoses included bowel obstruction due to gallstone ileus (n=1), perforated uterus from an intrauterine device (n=1), urinary bladder diverticulum (n=1), bleeding Meckel's diverticulum (n=3), and perforated duodenal ulcer (n=4). RESULTS: Each patient was treated with standard surgical interventions performed entirely laparoscopically with intracorporeal suturing. No morbidity or mortality occurred in any patient due to the operation. CONCLUSIONS: Although each of these operations has been previously reported, as a series, they point out the importance of mastering laparoscopic suturing. Although devices are commercially available to facilitate certain suturing scenarios, we encourage residents and fellows to sew manually. We believe that none of these operations could have been completed as effectively by using a suture device. The ability to suture laparoscopically markedly broadens the number of clinical scenarios in which minimal access techniques can be used.