Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Surgical smoke produced by use of electrocautery devices contains volatile gases (formaldehyde, acetaldehyde) that can cause symptoms such as eye, nose, and throat irritation, as well as headaches. Smoke also contains particulate matter including bacterial and viral particles that can spread diseases such as COVID-19. Dedicated smoke evacuators have been used to remove these irritants and particles, especially during minimally invasive procedures.
This randomized trial measured the efficacy of smoke evacuators in removing dangerous substances during laparoscopic abdominal operations. A total of 42 patient events were included in the analysis (n = 22 in the smoke evacuator group). The data analysis showed that levels of acetaldehyde and formaldehyde were reduced significantly in the evacuator group compared to the control group, with a more than 70% reduction. The reduction observed produced levels that were well within recommended safety ranges, and particle levels were reduced by 80%-95% depending upon particle size.
The authors concluded that use of dedicated smoke evacuators minimized exposure to toxic substances and potentially dangerous particles.
Article Reviews Recommendations for Management of Breast Cancer during Pregnancy
This article presented the recommendations for management of breast cancer in pregnant patients from an expert consensus panel convened by the European Society of Medical Oncology.
The panel members noted that randomized clinical trials are not possible in pregnant patients with breast cancer and that advances in breast cancer management shown to benefit patients who are not pregnant often cannot be used in pregnant patients because the health of the unborn child needs to be protected. Evidence presented showed that outcomes of breast cancer treated during pregnancy are similar to cancers treated in non-pregnant patients, but postpartum breast cancers have worse outcomes, over long-term follow up, compared to cancers occurring in patients who have not been pregnant.
Breast cancers diagnosed during pregnancy are increasing, possibly because of patients choosing to become pregnant later in life. Diagnostic options that should be avoided include the use of contrast-enhanced MRI.
Chemotherapy should be avoided in the first trimester of pregnancy, and radiation therapy can be utilized with appropriate fetal protection. Antiemetic medications can be used to treat chemotherapy-associated nausea and vomiting at normal doses in pregnant patients. Operative management of pregnant patients with breast cancer should be conducted with adequate positioning and monitoring to protect the fetus.
These and other recommendations are clearly described in the article and are easily readable. Surgeons are encouraged to review the full content of the article.
Study Suggests Surgical Treatment of Appendicitis Reduces Mortality in Multimorbid Patients versus Nonoperative Management
Nonoperative management of appendicitis has been shown to be an effective approach; however, available evidence supporting nonoperative management is derived mostly from studies of young, healthy patients. The authors of this study used data from the National Inpatient Sample to determine outcomes of operative and nonoperative management of appendicitis in patients with or without multiple comorbid conditions.
Data from 368,537 patients with acute, uncomplicated appendicitis who were classified as having no comorbid conditions or more than two comorbid conditions were matched using propensity scoring; outcomes in patients treated with surgery or nonoperative management were compared for patients with and without comorbid conditions. Nonoperative management was used in 5% of patients without comorbidities compared to 20% of patients with comorbidities.
Nonoperative management was associated with a 3.5% decrease in complications in multimorbid patients but a 1.5% increase in mortality for this group. Total costs and lengths of hospital stay were significantly lower in patients managed operatively.
The authors concluded that the reported benefits of nonoperative management are not observed in patients with multiple comorbid conditions.
