jueves, 3 de diciembre de 2009

Surgical Clinics of North America Volume 89, Issue 5, Pages 1047-1278 (October 2009)

Surgical Clinics of North America
Volume 89, Issue 5, Pages 1047-1278 (October 2009)
Endocrine Surgery
Edited by Martha A. Zeige
As one reads this issue one will find a significant amount of material addressing operative techniques. One will also find an expanse of material relating to the molecular, biochemical, imaging, genetic, genomic, and proteomic aspects of what is known about endocrinology. I can think of few other areas of study where we have advanced as much in our ability to more fully understand the physiologic and structural aspects of pathologic target organs preoperatively as we now can in endocrine surgery. These advances have in some cases allowed us to significantly and reliably reduce our need to dissect and explore at the time of operation. Conversely, we may decide to reliably expand our initial operative plans based on gene analysis.

It has been quoted (multiple times in just this issue) that the most important localizing study in endocrine surgery is to localize a competent endocrine surgeon. The corollary for that could be that the surgeon who desires becoming facile and well-employed as an endocrine surgeon must localize an endocrinologist (or preferably group) with whom he or she can work well. Part of this relationship will likely depend on having an excellent working knowledge of the nonoperative aspects of endocrinology.

Despite the desires of the American Board of Surgery to claim that all general surgeons who are board certified have demonstrated expertise in endocrine surgery, the reality of the practice place is that these operations are almost always performed by persons with additional training and defined focus in one or more subsets of endocrine surgery. To be sure, there is overlap with otorhinolaryngologists, surgical oncologists, and hepatopancreatobiliary surgeons in the management of these patients but the reality that “specialty-” and “subspecialty”-trained surgeons perform the lion's share of these procedures is inescapable.

General surgeons will still maintain a need for knowledge in these areas. If for no other reason, endocrinopathies—both recognized and unrecognized—may be encountered in other patients and must be understood to safely manage their care. Also, we remain in a highly dynamic state regarding the delivery of health care. As events unfold, there may be a need to shift workforce supply and care distribution. Given the relative distribution of general surgeons compared with subspecialists, it is not inconceivable that some aspect of care previously relegated by degrees by some general surgeons may need to be reconsidered. A more important reason to be familiar with the larger breadth of material is because that is what is required for mastery of the topic. In an age where more people are looking for “just-in-time” information about small topics, mastery is becoming rarer. For those whom surgery is a passion, mastery is imperative.

Dr Zeiger and her colleagues have assembled an excellent group of reviews that should be informative and enlightening to any interested student of endocrine surgery.


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