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Carotid artery surgery: A problem based approach
BOOK REVIEWS Atlas of Cancer Surgery Bloom N, Beattie E, Harvey J, eds. Philadelphia, Pa: W.B. Saunders, 2000, 495 pp, $140.00. When preparing for a major cancer operation, both experienced surgeons and surgeons-in-training often like to have a succinct source to review the anatomy and steps involved in the operation. Atlas of Cancer Surgery serves as an excellent launching point for such preparation. This comprehensive atlas is divided into 6 sections, with 4 sections corresponding to major anatomical areas. The fifth and sixth sections are dedicated to radical amputations and breast/ soft tissue, respectively. Each section starts with a review of the relevant anatomy of the area followed by illustrations with appropriate legends for specific operations in that area. The illustrations are all done in halftone and are all by the same illustrator, thus, providing consistency in the presentation. The authors’ goal is to stress anatomy and anatomic relationships. The illustrations are clearly labeled and include cut-away and overlay views to help elucidate the anatomic relationships. The chapters dealing with specific procedures include figures illustrating the main steps in the procedure as well as succinct legends. The authors do not describe specific intraoperative techniques, but keep the legends generalized to the main steps of the operations. The scope of the atlas is comprehensive. Most major general surgical oncologic procedures are included. The book includes illustrations on common procedures such as sigmoid colectomy, thyroid lobectomy, and modified radical mastectomy as well as less common procedures such as pelvic exenteration, radical cholecystectomy, and trisegmentectomy. The book includes a comprehensive section on radical amputations, which would be difficult to find in any standard surgical atlas. This inclusion of many unusual and relatively rare operations is one of the strengths of this book. Some cases are not included in the atlas, such as resection of proximal cholangiocarcinoma and pneumonectomy. However, the anatomy relevant to these and other areas are covered in detail. The atlas deals primarily with more radical operations and does not address any less invasive techniques, such as sentinel lymph node biopsy, laparoscopic staging, or laparoscopic colectomy. Although it is not the goal of the authors to describe specific operative techniques, at times, the legends are oversimplified. This lack of detail is the main weakness of this atlas and in some instances leaves the reader wanting more information. Potential operative pitfalls and interval steps are not included in the legends. Because of these simplifications, this atlas is not the best choice for the surgeon who is learning to perform a new procedure. However, the first-rate illustrations and concise legends make it a very valuable resource for the surgeon who wants to review relevant surgical anatomy before performing a case with which they have past experience. This text is not a resource that 452
should stand as the sole atlas in the general surgeon’s library, but it is an excellent supplement for surgeons whose practice includes cancer surgery. Because of its excellent illustrations and concise notations, Atlas of Cancer Surgery will be called on whenever I am preparing for a major cancer operation. CARLYLE M. DUNSHEE, II, MD Department of Surgery Brody School of Medicine East Carolina University Greenville, North Carolina PII S0149-7944(01)00431-7
Carotid Artery Surgery: A Problem Based Approach Naylor AR, Mackey WC, eds. Philadelphia, Pa: W.B. Saunders, 2000, 426 pp, $95.00. Carotid endarterectomy surgery (CEA) remains one of the most common procedures performed by vascular surgeons. Despite the regularity with which it is performed and the scrutiny it has undergone with evidence-based trials, controversy still surrounds this procedure. New approaches to perioperative care, diagnostic and surgical techniques, and indications for CEA are reported in the vascular literature on a regular basis. The editors, aided by over 50 contributing authors, address controversies surrounding carotid surgery using a problem and outcomes approach. The authors begin by establishing patient selection guidelines for performing carotid artery surgery. The groundwork for this section of the book is laid by discussing the European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET), the 2 most significant trials evaluating CEA. Next, the authors embark on detailed discussions that encompass many clinical aspects of carotid artery surgery and controversies surrounding CEA. Subjects include patient selection, including a detailed discussion on surgery for asymptomatic disease, emergent or urgent CEA, and the timing of surgery after stroke. The discussion on evaluation and preoperative management focuses on ultrasound, contrast angiography, and magnetic resonance angiography, as well as on neurologic and cardiac evaluations. Medical management is likewise discussed in detail. The section on operative care tackles the subjects of anesthesia, shunting, patching, and the possible role of minimally invasive carotid angioplasty and stenting. Postoperative management is not excluded, with commentary on surveillance and management of complications, including stroke, restenosis, and infected prosthetics. This book differs from others on carotid artery surgery by providing insight and expert commentary from surgeons from both the United States and Europe. Clinical experiences have differed in some cases between the continents. Each chapter is
CURRENT SURGERY • © 2001 by the Association of Program Directors in Surgery Published by Elsevier Science Inc.
0149-7944/01/$20.00
written in 2 parts, in which a surgeon from each continent provides a review of the literature and evidence-based medicine as well as adding their experiences and opinions. The clinical controversies, problems, and areas of agreement are clearly summarized by each contributing author. Overall, this book provides a detailed review and thoughtful insights into carotid artery surgery for those involved in treating carotid artery disease. For surgeons in training, this book, through its problem-based approach, provides a thorough discussion of carotid artery disease, treatment, and problems that one encounters daily on a vascular service. Experienced vascular surgeons will also find the evidence-based proof and transcontinental views unique and clinically relevant. Interventional radiologists, cardiologists, and other physicians participating in the care of patients with carotid artery disease will be able to incorporate subjects from this book into their clinical practice. STEPHEN OLENCHOCK, DO Department of Surgery St. Luke’s Hospital Bethlehem, Pennsylvania PII S0149-7944(00)00447-5
The Woman in the Surgeon’s Body Cassell J, ed. Cambridge, Mass: Harvard University Press, 2000, 267 pp, $17.95. The author writes a thoughtful, yet riveting study about women surgeons and women in surgical training programs. She is not a novice at studying surgeons. She began studying the profession in the early 1980s and has written several papers and a book about the subject. When queried about why she would study surgeons, she replied “well, there were no other primitives left” (p. 10). How true. Back then, she felt that her comment may have been too harsh, but after reading this fast-paced book, one might think that the comment was all too true. This book is a must for any program director, anyone advising medical students (not only female students), or any woman or man entering surgery. The stunning thing that hits the reader, if one pauses enough to ponder the timing of this book, is just that—the time. The “stories” every surgeon has heard (approvingly or disapprovingly) about women in surgery are all thought to be “passe´.” These things “don’t happen anymore.” Dr. Cassell began her research around 1995, and the book was first published in 1998. According to most surgical text standards, this is “real-time.” This is now. These things are happening in surgical residencies today. Although the most overt sexual harassment does tend to be “passe´” in most programs (if for no other reason than a legal one), the danger is to think that the prejudice against women has also passed. Gender bias is very much alive, much more subtle, and lies much more in the attitudes, the treatment by other residents, the discussion groups, the grilling at morbidity and mortality conferences, the perks bestowed, the sharing of the case, the sharing of knowledge, the steering of who goes into what subspecialty (ie,
women in general surgery are steered into breast surgery, which is low-prestige, low-compensated, “easy”). This book does an excellent job of bringing out these frightening subtleties. This book is a must read for those in charge of residents, but also for those who work with women surgeons—residents and attendings. The book describes how women surgeons perceive themselves and how they are perceived by their colleagues. More importantly, it teaches their male counterparts what their roles have been and still are, when dealing with a woman surgeon. It is also important to state that this is not a male-bashing, militant feminist book about how women are treated so unfairly by the “boys.” This book is thoughtful and objective. When trying to make a specific point, the author lets the women tell their stories, which to most readers, makes it clear what the point is. Then, Dr. Cassell applies sound analysis to these stories and situations, often comparing with her experience when studying male surgeons several years earlier. She often highlights the similarities between the women surgeons and the men surgeons and does not focus solely on the differences. However, she does bring out the differences in fairly nonjudgmental ways, focusing more on why differences exist and not emphasizing which way is better. She also highlights other people’s attitudes (nurses, patients) toward these women and how their attitudes help or more often hinder a woman’s pursuit of becoming a surgeon. Dr. Cassell covers a wide variety of topics in the book. She studied women from many different surgical subspecialties. She interviewed and studied women of vastly different ages, from the early trailblazers to current-day residents. She describes the plight of the woman surgeon caught trying to navigate the ropes—from the overachiever resident who was punished or not promoted or given the perks to the women who “gave up” and went into breast surgery. Dr. Cassell touches on the role of the occasional “other” woman resident, often describing colleagues as trying to keep the women divided (“she’s a bitch, stay out of her way”) or apply pressure (“I hope you aren’t like the last woman we had in the program. . .”). She also discusses the role of the spouse, “a woman surgeon’s husband must be committed to her being a surgeon” (p. 174) as well as a wife and mother. Still, both the husband and the surgeon-wife frequently assume that the running of the home is still the responsibility of the woman, including hiring and supervising the hired help. Another interesting and probably generally true observation is that (a particular woman) was “intellectually and surgically gifted. . .but apparently socially and politically blind. Obviously, she needed a mentor” (p. 205). Mentors for woman are rare. Few senior men can do this task.
CURRENT SURGERY • Volume 58/Number 5 • September/October 2001
MARIAN PASSARO MCDONALD, MD Department of Surgery St. Luke’s Hospital Bethlehem, Pennsylvania PII S0149-7944(00)00476-1 453
should stand as the sole atlas in the general surgeon’s library, but it is an excellent supplement for surgeons whose practice includes cancer surgery. Because of its excellent illustrations and concise notations, Atlas of Cancer Surgery will be called on whenever I am preparing for a major cancer operation. CARLYLE M. DUNSHEE, II, MD Department of Surgery Brody School of Medicine East Carolina University Greenville, North Carolina PII S0149-7944(01)00431-7
Carotid Artery Surgery: A Problem Based Approach Naylor AR, Mackey WC, eds. Philadelphia, Pa: W.B. Saunders, 2000, 426 pp, $95.00. Carotid endarterectomy surgery (CEA) remains one of the most common procedures performed by vascular surgeons. Despite the regularity with which it is performed and the scrutiny it has undergone with evidence-based trials, controversy still surrounds this procedure. New approaches to perioperative care, diagnostic and surgical techniques, and indications for CEA are reported in the vascular literature on a regular basis. The editors, aided by over 50 contributing authors, address controversies surrounding carotid surgery using a problem and outcomes approach. The authors begin by establishing patient selection guidelines for performing carotid artery surgery. The groundwork for this section of the book is laid by discussing the European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET), the 2 most significant trials evaluating CEA. Next, the authors embark on detailed discussions that encompass many clinical aspects of carotid artery surgery and controversies surrounding CEA. Subjects include patient selection, including a detailed discussion on surgery for asymptomatic disease, emergent or urgent CEA, and the timing of surgery after stroke. The discussion on evaluation and preoperative management focuses on ultrasound, contrast angiography, and magnetic resonance angiography, as well as on neurologic and cardiac evaluations. Medical management is likewise discussed in detail. The section on operative care tackles the subjects of anesthesia, shunting, patching, and the possible role of minimally invasive carotid angioplasty and stenting. Postoperative management is not excluded, with commentary on surveillance and management of complications, including stroke, restenosis, and infected prosthetics. This book differs from others on carotid artery surgery by providing insight and expert commentary from surgeons from both the United States and Europe. Clinical experiences have differed in some cases between the continents. Each chapter is
CURRENT SURGERY • © 2001 by the Association of Program Directors in Surgery Published by Elsevier Science Inc.
0149-7944/01/$20.00
written in 2 parts, in which a surgeon from each continent provides a review of the literature and evidence-based medicine as well as adding their experiences and opinions. The clinical controversies, problems, and areas of agreement are clearly summarized by each contributing author. Overall, this book provides a detailed review and thoughtful insights into carotid artery surgery for those involved in treating carotid artery disease. For surgeons in training, this book, through its problem-based approach, provides a thorough discussion of carotid artery disease, treatment, and problems that one encounters daily on a vascular service. Experienced vascular surgeons will also find the evidence-based proof and transcontinental views unique and clinically relevant. Interventional radiologists, cardiologists, and other physicians participating in the care of patients with carotid artery disease will be able to incorporate subjects from this book into their clinical practice. STEPHEN OLENCHOCK, DO Department of Surgery St. Luke’s Hospital Bethlehem, Pennsylvania PII S0149-7944(00)00447-5
The Woman in the Surgeon’s Body Cassell J, ed. Cambridge, Mass: Harvard University Press, 2000, 267 pp, $17.95. The author writes a thoughtful, yet riveting study about women surgeons and women in surgical training programs. She is not a novice at studying surgeons. She began studying the profession in the early 1980s and has written several papers and a book about the subject. When queried about why she would study surgeons, she replied “well, there were no other primitives left” (p. 10). How true. Back then, she felt that her comment may have been too harsh, but after reading this fast-paced book, one might think that the comment was all too true. This book is a must for any program director, anyone advising medical students (not only female students), or any woman or man entering surgery. The stunning thing that hits the reader, if one pauses enough to ponder the timing of this book, is just that—the time. The “stories” every surgeon has heard (approvingly or disapprovingly) about women in surgery are all thought to be “passe´.” These things “don’t happen anymore.” Dr. Cassell began her research around 1995, and the book was first published in 1998. According to most surgical text standards, this is “real-time.” This is now. These things are happening in surgical residencies today. Although the most overt sexual harassment does tend to be “passe´” in most programs (if for no other reason than a legal one), the danger is to think that the prejudice against women has also passed. Gender bias is very much alive, much more subtle, and lies much more in the attitudes, the treatment by other residents, the discussion groups, the grilling at morbidity and mortality conferences, the perks bestowed, the sharing of the case, the sharing of knowledge, the steering of who goes into what subspecialty (ie,
women in general surgery are steered into breast surgery, which is low-prestige, low-compensated, “easy”). This book does an excellent job of bringing out these frightening subtleties. This book is a must read for those in charge of residents, but also for those who work with women surgeons—residents and attendings. The book describes how women surgeons perceive themselves and how they are perceived by their colleagues. More importantly, it teaches their male counterparts what their roles have been and still are, when dealing with a woman surgeon. It is also important to state that this is not a male-bashing, militant feminist book about how women are treated so unfairly by the “boys.” This book is thoughtful and objective. When trying to make a specific point, the author lets the women tell their stories, which to most readers, makes it clear what the point is. Then, Dr. Cassell applies sound analysis to these stories and situations, often comparing with her experience when studying male surgeons several years earlier. She often highlights the similarities between the women surgeons and the men surgeons and does not focus solely on the differences. However, she does bring out the differences in fairly nonjudgmental ways, focusing more on why differences exist and not emphasizing which way is better. She also highlights other people’s attitudes (nurses, patients) toward these women and how their attitudes help or more often hinder a woman’s pursuit of becoming a surgeon. Dr. Cassell covers a wide variety of topics in the book. She studied women from many different surgical subspecialties. She interviewed and studied women of vastly different ages, from the early trailblazers to current-day residents. She describes the plight of the woman surgeon caught trying to navigate the ropes—from the overachiever resident who was punished or not promoted or given the perks to the women who “gave up” and went into breast surgery. Dr. Cassell touches on the role of the occasional “other” woman resident, often describing colleagues as trying to keep the women divided (“she’s a bitch, stay out of her way”) or apply pressure (“I hope you aren’t like the last woman we had in the program. . .”). She also discusses the role of the spouse, “a woman surgeon’s husband must be committed to her being a surgeon” (p. 174) as well as a wife and mother. Still, both the husband and the surgeon-wife frequently assume that the running of the home is still the responsibility of the woman, including hiring and supervising the hired help. Another interesting and probably generally true observation is that (a particular woman) was “intellectually and surgically gifted. . .but apparently socially and politically blind. Obviously, she needed a mentor” (p. 205). Mentors for woman are rare. Few senior men can do this task.
CURRENT SURGERY • Volume 58/Number 5 • September/October 2001
MARIAN PASSARO MCDONALD, MD Department of Surgery St. Luke’s Hospital Bethlehem, Pennsylvania PII S0149-7944(00)00476-1 453