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| Report: 1.2 Million Hospital Patients Infected With MRSA Each Year
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In a step forward for the experimental and controversial practice of natural orifice surgery, surgeons at the Oregon Clinic in Portland have successfully completed the first-in-the-U.S. transgastric endoscopic cholecystectomies, in which three patients' gall bladders were removed via their mouths.
According to the clinic, Lee Swanstrom, MD, and his surgical team inserted flexible instruments through the patients' mouths and throats, made incisions in their stomachs, laparoscopically removed their gall bladders and closed the incisions. None of the patients suffered any complications and all reported rapid recoveries, says the clinic.
"These initial cholecystectomy procedures are an important first step in the development of methods and devices to enable the widespread adoption of incisionless natural orifice transluminal endoscopic surgery," says Dr. Swanstrom, director of the clinic's division of gastrointestinal and minimally invasive surgery and a founding member of the Natural Orifice Surgery Consortium for Assessment and Research, or NOSCAR.
"In our first patients, we used two or three small laparoscopic ports to assess the safety of the procedure and to assist in the refinement of the technique. As we continue to gain experience, our protocol allows us to begin to eliminate these external ports," he says.
The advance follows on the heels of other natural orifice procedures, including the surgical removal of a woman's gall bladder through her vagina, a video of which was presented at the SAGES conference this spring.
"Operating through the body's natural orifices offers promise for faster healing times, less scarring and less pain, which could lead to reduced hospitalization and quicker recovery," says David W. Rattner, MD, co-chair of NOSCAR's ASGE/SAGES joint committee and chief of general and gastrointestinal surgery at Massachusetts General Hospital in Boston.
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| Log On to CDC's Infection Tracking System
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In a step forward for the experimental and controversial practice of natural orifice surgery, surgeons at the Oregon Clinic in Portland have successfully completed the first-in-the-U.S. transgastric endoscopic cholecystectomies, in which three patients' gall bladders were removed via their mouths.
According to the clinic, Lee Swanstrom, MD, and his surgical team inserted flexible instruments through the patients' mouths and throats, made incisions in their stomachs, laparoscopically removed their gall bladders and closed the incisions. None of the patients suffered any complications and all reported rapid recoveries, says the clinic.
"These initial cholecystectomy procedures are an important first step in the development of methods and devices to enable the widespread adoption of incisionless natural orifice transluminal endoscopic surgery," says Dr. Swanstrom, director of the clinic's division of gastrointestinal and minimally invasive surgery and a founding member of the Natural Orifice Surgery Consortium for Assessment and Research, or NOSCAR.
"In our first patients, we used two or three small laparoscopic ports to assess the safety of the procedure and to assist in the refinement of the technique. As we continue to gain experience, our protocol allows us to begin to eliminate these external ports," he says.
The advance follows on the heels of other natural orifice procedures, including the surgical removal of a woman's gall bladder through her vagina, a video of which was presented at the SAGES conference this spring.
"Operating through the body's natural orifices offers promise for faster healing times, less scarring and less pain, which could lead to reduced hospitalization and quicker recovery," says David W. Rattner, MD, co-chair of NOSCAR's ASGE/SAGES joint committee and chief of general and gastrointestinal surgery at Massachusetts General Hospital in Boston.
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| Needlestick Injuries Underreported by Surgical Residents, Study Says
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Surgical residents are at high risk for needlestick injuries and often fail to report them when they do occur, according to a study published in the June 28 issue of The New England Journal of Medicine.
Researchers surveyed close to 700 surgeons-in-training at 17 medical centers in 2003. They determined that 99 percent of those polled suffered an average of eight needlestick injuries in their first five years of practice. Of those injured, 53 percent experienced an injury involving a patient with a history of intravenous drug use or HIV, hepatitis B or hepatitis C infections. But only 49 percent reported the incidents to employee health services.
The researchers note that 57 percent of the residents blamed their injuries on feeling rushed during surgery. Another 42 percent claimed they did not report the injuries because the reporting process was too time-consuming and 28 percent believed reporting the incidents served no purpose.
Martin Makary, MD, MPH, a surgeon at The Johns Hopkins Hospital in Baltimore and the study's lead author, says hospitals must strive to better protect their employees. He adds that the incidence of sharps injuries could be greatly reduced by the increased use of nurse practitioners and physician assistants to reduce surgical workloads and a greater reliance on sharpless surgical supplies such as electric scalpels, clips and glues.
"We did not realize the extent to which healthcare workers are at risk - a risk that is preventable," says Dr. Makary. "Many residents resist reporting because the training culture suggests that needle sticks go with the territory and reporting them may lower peer esteem."
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| News and Notes
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Surgical residents are at high risk for needlestick injuries and often fail to report them when they do occur, according to a study published in the June 28 issue of The New England Journal of Medicine.
Researchers surveyed close to 700 surgeons-in-training at 17 medical centers in 2003. They determined that 99 percent of those polled suffered an average of eight needlestick injuries in their first five years of practice. Of those injured, 53 percent experienced an injury involving a patient with a history of intravenous drug use or HIV, hepatitis B or hepatitis C infections. But only 49 percent reported the incidents to employee health services.
The researchers note that 57 percent of the residents blamed their injuries on feeling rushed during surgery. Another 42 percent claimed they did not report the injuries because the reporting process was too time-consuming and 28 percent believed reporting the incidents served no purpose.
Martin Makary, MD, MPH, a surgeon at The Johns Hopkins Hospital in Baltimore and the study's lead author, says hospitals must strive to better protect their employees. He adds that the incidence of sharps injuries could be greatly reduced by the increased use of nurse practitioners and physician assistants to reduce surgical workloads and a greater reliance on sharpless surgical supplies such as electric scalpels, clips and glues.
"We did not realize the extent to which healthcare workers are at risk - a risk that is preventable," says Dr. Makary. "Many residents resist reporting because the training culture suggests that needle sticks go with the territory and reporting them may lower peer esteem."
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