The learning curve for performing colorectal resections was approximately 30 procedures in this study, based on a decline in operating time, intraoperative complications, and conversion rate. Learning was also extended to clinical care because it was appreciated that patients could be discharged to their homes more quickly.

A systematic review of the factors affecting choice of surgery as a careerBackground: Interest in surgical careers among medical students has declined over the past decade. Multiple explanations have been offered for why top students are deterred or rejected from surgical programs, though no consensus has emerged. Methods:We conducted a review of the literature to better characterize what factors affect the pursuit of a surgical career. We searched PubMed and EMBASE and performed additional reference checks. Agency for Healthcare Research and Quality (AHRQ) and Newcastle-Ottawa Education scores were used to evaluate the included data.Results: Our search identified 122 full-text, primary articles. Analysis of this evidence identified 3 core concepts that impact surgical career decision-making: gender, features of surgical education, and student "fit" in the culture of surgery. Conclusion:Real and perceived gender discrimination has deterred female medical students from entering surgical careers. In addition, limited exposure to surgery during medical school and differences between student and surgeon personality traits and values may deter students from entering surgical careers. We suggest that deliberate and visible effort to include women and early-career medical students in surgical settings may enhance their interest in carreers in surgery.Contexte : On constate que l'intérêt pour une carrière en chirurgie a décliné chez les étudiants en médecine depuis une dizaine d'années. Plusieurs raisons ont été invoquées pour expliquer le désintérêt des étudiants talentueux à l'égard des programmes de chirurgie ou leur rejet de ces programmes, sans qu'on en arrive à un consensus.

The results indicate that LTAC can be performed safely with a statistically significant reduction in wound and long-term postoperative complications, as compared with its open counterpart. Operating time is increased, but there is a marked reduction in length of hospital stay. Preliminary results demonstrate that LTPC also is technically feasible and safe, with equal morbidity, mortality, and hospital stay, as compared with open procedures. Studies with larger numbers of patients and a randomized controlled trial giving special attention to patient quality-of-life issues are needed to elucidate the real advantages of this minimally invasive technique.

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Preoperative splenic artery embolization is not necessary for spleens shorter than 20 cm. Increased experience and mostly the lateral surgical approach have permitted a shorter operation and a low conversion rate (4%) similar to the rate achieved with embolization and the anterior approach in the initial stages of the study. Embolization is used for 20- to 30-cm spleens. The conversion rate is higher (17%), and blood replacement is required frequently (83%). Despite embolization, laparoscopic splenectomy for spleens longer than 30 cm is futile at this time (100% conversion).

Improved microsurgical techniques for kidney transplantation in the mouse are described. Left renal transplantation is performed with end-to-side anastomoses of the donor renal vein to the inferior vena cava and the donor aortic cuff to the aorta. Urinary tract reconstruction is accomplished by suturing the donor ureter with a bladder patch to the recipient bladder. With these modifications, it is possible to achieve success rates as high as 90%. This stable and reproducible model provides a useful tool to study the immunological mechanisms of kidney allograft rejection at the molecular level.

The use of videotapes of operations enabled multiple raters to assess a performance reliably and shortened assessment times by 80%. This assessment technique shows potential as a means of evaluating the performance of advanced laparoscopic procedures by surgical trainees.

ObjectiveTo determine the survival curves for laparoscopic resection (LR) of colorectal cancer. Summary Background DataLaparoscopic resection for cure of colorectal cancer is controversial, and survival curves have not been determined. One of the most controversial areas of laparoscopic surgery has been laparoscopic resection (LR) for cancer, more specifically for colon and rectal cancer. 1'2 This controversy has been fueled by well-publicized anecdotal reports of port-site recurrences in patients undergoing surgery for a variety of neoplas- Methods