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Fri Mar 30 23:30:06 BST 2007

I do not about down under, but in the US there are still open trachs being
done as part of the general surgical training program, usually on trauma
patients with cervical spine injuries in which perc trach may be
contraindicated, or on patients with poor landmarks or such. This has not
defailted to specialists; the ENT surgeons are too busy doing facial plastic
surgery. The dedicated trauma surgeon (especially with surgical critical
care credentials which is becoming the norm) is the last bastion of true
general surgery. Call one of us.

Jeffrey Hammond MD, MPH
Chief, Trauma/Surgical Critical Care
Robert Wood Johnson Medical School
New Brunswick, NJ
ph: 732-235-7920
e-mail: hammond at umdnj.edu

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ian Seppelt
Sent: Friday, March 30, 2007 1:37 AM
To: Jeffry.Kashuk at dhha.org; Trauma &amp; Critical Care mailing list
Subject: RE: Extinction of Non laparoscopic surgeons

It's not just laparoscopic surgery! I worry a bit about the future "demise"
of open tracheostomy .....

Intensive care practice has changed radically in the last decade or so, and
while will obviously vary a bit between institutions and perhaps countries,
in Australia the majority of tracheostomies are now being done
percutaneously by intensivists, and only the "truly difficult" ones are
being referred to specific surgeons with head and neck expertise. In term of
training, it means that surgical trainees who used to do all the easy
tracheostomies do none, because intensive care trainees do all the easy
tracheostomies. Harder ones are done by specific intensivists with an
interest, etc. In all, we do over 100 per year in the ICU, of which less
than 10 are done surgically. Moreover, there is only a small list of
surgeons in my hospital whom I would ask to get me out of trouble of my own
creation, and they are all over 50 years old.

So in 20 years time, who is going to rescue my airway disaster when no
junior surgeons aside from specialist head and neck surgeons do
tracheostomies any more?!!! [Having said that I have only had to call for
surgical help once in over 500 tracheostomies, and he just stood next to me
and reassured me that the mess I thought I had created was actually not such
a mess at all, but it's going to happen one day...]

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751 Clinical Lecturer,
University of Sydney

>>> Jeffry.Kashuk at dhha.org 30/03/2007 1:57am >>>
This is precisely why the Acute Care Surgery paradigm is so important.
The comprehensive surgeon in this arena needs to know "maximally invasive"
as well as minimally invasive techniques... 
Jeffry L. Kashuk, M.D, FACS
Surgery, Trauma, Surgical Critical Care
Denver Health Medical Center
777 Bannock St, MC 0206
Denver, CO 80204
Ph 303-436-6558
Fax 303-436-6572

-----Original Message-----
From: Jeffrey Hammond [mailto:hammond at umdnj.edu]
Sent: Wednesday,March 28,2007 11:28 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Extinction of Non laparoscopic surgeons

Those of us over 50 are beginning to joke that we'll soon need a Fellowship
in "Open Surgery." Meanwhile, we are now graduating residents who have had
limited experience in things we once considered not only bread and butter
(e.g. gastric surgery) but also a required skill set (e.g.CBD explorations).
I wonder how they'll get out of trouble when we're old and they're operating
on us!

Jeffrey Hammond MD, MPH
Chief, Trauma/Surgical Critical Care
Robert Wood Johnson Medical School
New Brunswick, NJ
ph: 732-235-7920
e-mail: hammond at umdnj.edu 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ronald Gross
Sent: Wednesday, March 28, 2007 9:28 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Extinction of Non laparoscopic surgeons

Tim,

Not even in elective surgery - someone is going to have to know how to
operate on the complications encountered by the video-laparoscopic surgeon
who doesn't know how to operate under direct vision, or how to open the
cavity he/she has placed a scope into!  

Geez - did I really say what I was thinking???

Best wishes,
Ron

>>> "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za> 3/28/2007
>>> 10:14 AM >>>
Dr Khattar

Extinct in elective surgery maybe......Trauma and emergency general surgery
and in countries where the socio-economic conditions are poor - not likely!
We need to have surgeons who can feel comfortable in all cavities and with
all techniques; this is the palce of the Trauma/Acute Care general surgeon.

Regards
Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU) ATLS instructor
and DSTC Cape Town Course Director Intern program Coordinator: Surgery M.Med
(Emergency Medicine) Executive Committee member Clinical Head
(Director):
Diana Princess of Wales Trauma Unit Division of Surgery (General) Room
4064
Department of Surgical Sciences Tygerberg Hospital / University of
Stellenbosch PO Box 19063 Tygerberg 7505 Western Cape South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org]On Behalf Of rm khattar
Sent: Wednesday, March 28, 2007 2:46 PM
To: trauma-list at trauma.org 
Subject: Extinction of Non laparoscopic surgeons

I recently came across  book on laparoscpy in Urologic
malignancies in which authors claimed that non
laparoscopic surgeons would become history.What is the
opinion of leaders in trauma surgery like
Karim,Ken,ERF,Tim on this issue? I am and doing
predominantly open surgery and do not see this
happening at least in next 20 years.

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Extinction of Non laparoscopic surgeons