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Cyklokapron (Tranexamic Acid)

Dr. Karl Zucker, professor of surgery at the University Of Maryland School Of Medicine, a pioneer video surgeon, has developed a treatment for intractable stomach ulcers. With his video viewer, he finds and severs the vagus nerve, which normally triggers the release of acid in the stomach. The cut nerve cannot stimulate the release of excess acid. As a result, less acid flows out of the stomach and the ulcers have a chance to heal. This can be done with a traditional operation, but Dr. Zucker says he prefers his comparatively painless procedure. He adds that it has worked in 19 of 20 cases.
Dr. Cooperman predicts that most surgeons will employ the video surgery method within 5 years. Until then, surgeons must master the new procedures it entails. Dr. Andrew Warshaw, associate chief of surgery at Massachusetts General Hospital in Boston, is both enthusiastic and cautious about video surgery, saying, “Patients are going to be at some risk for a while. There was a wave of injuries caused by laparoscopic gallbladder surgeries. This has gotten better, but each new technique will go through that.”
Many surgeons have trouble, initially, comprehending in two dimensions what is going on in 3-D. For example, they may push their instruments too far or not far enough. Suturing is difficult – needle and thread may be 18 inches from the physician’s fingers, after all, and visible only on a TV screen.
Some surgeons seem unable to adjust, and Dr. Warshaw says he fears that refusal by such doctors to put aside the new surgery and resume the conventional methods they have mastered could put their patients at risk.
“It is important,” he says, “for surgeons to know when to quit and not consider it a defeat.” Otherwise, he notes, the defeated ones are the patients.
How does a patient know whether a video surgeon is competent? Experts say that once a doctor does at least 25 such surgeries, you can feel sure of that physician’s abilities. But, certainly, 100 surgeries are even more reassuring.
Surgeons often complain of a technology lag, saying too few instruments are designed especially for video surgery. Instrument companies are working to fill their quite specific needs. Under development is a direct-vision optical trocar that allows the surgeon to view the punctures at the very moment they are made.

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