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Robotic Technology Enhances TKR

Robotic Technology Enhances TKR

According to recent estimates, more than 4.7 million Americans are currently living with a prosthetic knee. The incidence of total knee replacement (TKR) increased by 120% from 2000 to 2009, but it has also increased by 188% for patients aged 45 to 64 and by 89% for patients aged 65 to 84. As a result of the growing popularity of TKR, technical advances are of great interest to surgeons and patients alike. Improvements in Technology The Omninav surgical navigation system (OMNIlife science, Inc.) is a device that was designed for TKR. It provides computer-guided precision and features bone morphing technology to allow surgeons to build a patient-specific three-dimensional model of the knee in real time. This creates a virtual surgical plan that can be used before making critical bone cuts. Navigation algorithms and adjustable resection guides enable surgeons to reconstruct the mechanical axis of a limb. No preoperative CT or MRI is required. The technology is complemented by a patented cutting guide, an intelligent robotic tool that automatically positions instruments. This can be helpful to optimize implant alignment. The instrumentation allows for simple, micrometric adjustments that can be made intraoperatively to ensure alignment and balance the knee joint. Real-time assessment of limb alignment and soft tissue can be made at any time during the procedure. After administration of regional and/or general anesthesia, any preferred surgical approach may be used. Reference markers are pinned onto the tibia and femur; this is then tracked by the computer in a three-dimensional space. Surgeons can then measure specific locations of the exposed knee joint. This approach allows surgeons to get a detailed, accurate...
Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

In 2005, the American Society of Clinical Oncology (ASCO) first published evidence-based clinical practice guidelines for using sentinel node biopsy (SNB) in patients with early-stage breast cancer. In 2014, these guidelines were updated and published in the Journal of Clinical Oncology. “Since publication of the original guidelines, several new randomized trial results and additional cohort studies have become available,” says Gary H. Lyman, MD, MPH, who co-chaired the ASCO expert panels for both versions of the guidelines. “We now have more evidence from clinical trials supporting the use of SNB as a less invasive cancer-staging technique for a larger group of patients.” Developing the Guidelines To develop the guideline update, ASCO convened experts in medical oncology, pathology, radiation oncology, surgical oncology, guideline implementation, and patient advocacy. A systematic review of the literature published from February 2004 to January 2013 in Medline was conducted. The subsequent recommendations were based on a review of the evidence. The update also includes an appendix on technical issues related to pathology. The ASCO guideline summarizes the updated literature search and analyzes new data related to the recommendations since the last systematic review. The update incorporates new evidence from more recent studies—including nine randomized controlled trials and 13 cohort studies—since 2005. Based on the results of these studies, more patients can now safely undergo SNB without axillary lymph node dissection (ALND). “The guidelines can help clinicians determine for whom SNB is appropriate,” says Dr. Lyman. “This may enable more women with early stage breast cancer to avoid ALND, which is more invasive and is associated with a greater risk of complications.” ALND can cause a...

What’s the Point of Medical Licensing?

A surgeon emailed me the following:. OK, I know this is radical but consider my argument… Medical licensing protects no one and costs physicians hundreds to thousands of dollars each year. If a physician is negligent, can the injured party sue the state that licensed him? I’m guessing not. When I moved to my current location, I had to send lots of documentation to the state medical board so they could verify that I was a true and competent surgeon. I provided my employer with the same info so they could also verify my credentials. Now my employer can and will get sued if I commit a negligent act and absolutely should verify my credentials prior to handing me a scalpel. But the state? Its license is useless. Most people choose a surgeon based on recommendations and word-of-mouth reputation, and these are by far better indicators of quality than any credentialing board. Nobody asks to see my license, and, even if they did, it would not protect them any more than their trust in the health system in which I work. If I was in private practice and had my license displayed on my wall, it may give some reassurance to my patients, but it does not say anything about the quality of my work. Most doctors who really screw up due to negligence are licensed by the state. I contend again, that word of mouth and reputation are the best indicators of a surgeon’s ability, anything beyond that is useless. Caveat emptor, “let the buyer beware” remains the mantra of the informed consumer. Thanks for letting me vent....
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