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Quick and easy-to-read case studies that improve surgical decision-making. Multiple scenarios in general and laparoscopic surgery explore various operative strategies and the rationale for selecting a given approach. Techniques are briefly described and illustrated and are accompanied by a short evidence-based review of the literature

Quick and easy-to-read case studies that improve surgical decision-making. Multiple scenarios in general and laparoscopic surgery explore various operative strategies and the rationale for selecting a given approach. Techniques are briefly described and illustrated and are accompanied by a short evidence-based review of the literature

Minimal access, whenever feasible, in the performance of most general surgical procedures is now well established. However, many areas still need clarifi cation. They range from indications and contraindications to the optimal route of access, as well as to choices to be made among the various procedures possible for any single surgical problem. This Manual is unique in that unlike most manuals it is not so much a how to but more a Уwhen to,Ф the Уhow toФ having been covered to a signifi cant extent in the two previous SAGES manuals. This work takes a series of common clinical scenarios and offers various, detailed, often contrasting approaches, commonly but not exclusively minimal access, discussing indications, limitations, and potential complications.

In this age of evidence-based surgical practice, the reader will find it refreshing to have abundant data and references to support or reject a particular approach or technique. With a cadre of surgeon authors skilled in open as well as minimal access surgery, including flexible endoscopy, the student and practitioner of surgery is exposed to not only varying approaches to many common surgical conditions but also comes to appreciate how fl exibility and integration of various approaches can improve the outcome for the patient.

The forty-six chapters can each constitute a stand-alone discussion. The format of each chapter is uniformly an introduction of the problem to be considered or question to be answered. This is followed by a case history, after which, in almost every instance two authors each declare his or her preference of approach and management, giving reasons and offering evidence, if it exists, and acknowledging lack of data if they are insuffi cient. Each chapter concludes with a summary discussion, bringing the reader up to date on the state of the art and making recommendations based on available data. Integration of ultrasound, MRI, PET scanning, and computed tomography is detailed when these modalities are employed for diagnosis or therapy as is the use of endoscopically deployed stenting for biliary tract and colonic obstructions.

Some topics, such as gastroesophageal refl ux, complicated as they are and controversial as their management often is, require more than one chapter for adequate discussion, and the editor, Dr. Carol E.H. Scott-Conner, is to be congratulated for her orchestration of these subjects, addressed as they are by multiple authors with minimal repetition evident to the reader. The inclusion of chapters on enteral access and nutrition, the discussions of management of complications of minimal access surgery, such bleeding and cystic duct stump leakage after laparoscopic cholecystectomy, opinions on when to convert to open operation are well treated. There is even detailed discussion of medical therapy when it is considered an appropriate alternative approach to a problem.

The contributing authors not only discuss differences in minimal access approaches but also address the integration of various methods of access (for example, fl exible endoscopic combined with laparoscopic), various tools of dissection (hand, ultrasound, thermal) as well as varying techniques of specimen retrieval and extraction.

The surgeon involved in advanced laparoscopic surgery will fi nd of special value the treatment of conditions that have been more recently managed by surgeons in specialties other than general surgery but, with overlapping training and practice, are increasingly performed by surgeons skilled in minimal access techniques.

While this work is labeled a Уmanual,Ф it is a veritable textbook, albeit not covering every imaginable aspect of minimal access surgery. It will provide guidance for those who are interested in putting into logical context the role of minimal access procedures in the management of diseases managed by surgeons rather than the sometimes unfortunate perception that the new and the old are in competition. While it does provide clear and detailed descriptions of some procedures, open, endoscopic, and combined, its greatest strength is in the new knowledge it summarizes and the results it shares.

These are changing times in the world of surgery. The face of surgery is changing and the face of those who perform surgery is changing. Many of these chapters may need revision as time passes, as instruments are retooled, new modalities introduced, and more results accumulated, but this work serves for the present as a practical guide and logical basis for which approach todayТs surgeon should consider and why. Since minimal access will be the common practice of surgery when they graduate, this work should be read by all surgical residents. It will obviously appeal to fellows in advanced laparoscopic training programs, to teachers as well as practitioners of minimal access surgery and, hopefully, to surgical program directors and their faculty at large. It should also be of special interest to those surgeons who received their instruction in a previous generation and wish to know more of the substance and less of the hyperbole of minimal access surgery.

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