These extensive demands placed on surgeons have led to the concept of the mini-fellowship.” These training programs in bariatric surgery last from 1 to 6 weeks and involve all phases of bariatric education with extensive operative and outpatient clinical experience.
The first decisional steps that any surgeon must take include the following: (1) analyze the population and determine the need for bariatric surgical services; (2) determine whether he or she can be committed to life-long follow-up and care of these patients; (3) develop an infrastructure and team to support Advanced Laparoscopic Surgery the surgical services, including trained medical assistants, primary care physicians, anesthesiologists, pulmonologists, psychologists, and other specialists as needed; and (4) decide whether he or she will perform these operations through a traditional laparotomy or using advanced laparoscopic techniques.
Scholz reports a median survival of 47 months and a 33% survival rate in a 5-year follow-up in a cohort of 101 patients affected of stage IIIC ovarian carcinoma with a high rate of extra procedures 31 With a high rate of bowel procedures (81% modified posterior exenteration and 19% ileocoecal resection), 56% splenectomies, 39% Glisson’s capsule resection and 22% cholecystectomies, and >80% rate of complete debulking, this institution gets 3 months of difference of mean time to disease recurrence (29 vs 26 months) between patients without gross residual disease and patients with post-operative residual disease.
A workshop involves procedural-specific information in combination with proven animal models in teaching laparoscopic surgical methods 34. This usually includes an 8-hour didactic lecture, half a day of animal lab, and half a day observing live surgery.
The American College of Surgeons has provided guidelines for facilities wishing to perform bariatric surgery 38. These include specialized operating suites with tables to accommodate patients weighing up to 750 pounds, appropriate retractors, staplers, and longer instruments.
To improve the cytoreductive rates in the actual management strategy, a change is necessary, selecting the cases not suitable for primary debulking surgery and adding, if necessary, procedures different than the ovarian tumour resection, like bowel resections, peritonectomies (particularly diaphragmatic ones) and splenectomies.
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