The majority of the obese population still does not take advantage of the available surgical possibilities. Clinical research should be oriented towards less invasive procedures that could be accepted by the mainstream. In 2012, most non-invasive bariatric techniques are still not standardized or sufficiently assessed, but they are being constantly upgraded. The purpose of this book is to spark a discussion between experts from around the world, and to gather relevant information on new technologies that will make it possible to enlarge the vision of bariatric care to a growing number of morbid obese and non-morbid obese patients.

1. Clinical cases set out as questions that are mapped directly to the curriculum and following the order of the RCoA curriculum 2. A focus on clinical anaesthesia with common cases, that can be used in the clinical environment either for teaching or as a refresher 3. Short, quick-fire cases that enable learning and retention of information with a summary of key points to remember for each question

Embryoimplantationisaremarkableandcomplexprocess. Approachesde- velopedfromthefieldsofcellanddevelopmentalbiology,immunology, andmolecularbiologyhavegreatlyenhancedourabilitytostudythe sharedaswellasuniquefeaturesofembryo-uterineinteractions. Impres- siveandcriticalgroundworkhasbeenlaidbyalargeanddedicatedarray ofendocrinologists,reproductivebiologists,andanatomists. Thesestudies havesetthestagetoutilizesensitiveandsophisticatedtechniquestode- tectandmodulateproteinandgeneexpression. Justasthesymbiosisofmother andfetusiscriticalforthemaintenanceofpregnancy,soisthesynergyamong investigatorsfrommanydisciplines,bothinbasicandclinicalarenas,keyto unravelingthemysteriesofimplantationandplacentation. Alargegroupof contributorsinthisfieldhadtheopportunitytomeetanddiscussthestateof thisartwiththesupportofSeronoSymposiaUSA,Inc. Whileitisneverpos- sibletobringtogethereveryonewhohasplayedanimportantrole,itwas, nonetheless,bothexcitingandgratifyingtohavesomanycolleaguestogether forthisevent. Inthechaptersthatfollow,thehighlightsofthismeetingarepresented assummarizedbytheindividualpresentersofsevendifferentsessions. The topichasbeenconsideredfromthebroadsocialandethicalimplications ofmoderninvitrofertilizationandassistedreproductivetechnologiesto detailedmolecularcontrolsovereventsthatoccurduringembryonicdevel- opment,uterinepreparationforimplantation,andplacentalorganogenesis. Thesechaptersdemonstratethesignificantandrapidprogressbeingmade inthisfieldofbiologyandmedicine. Atthesametime,theyshowthat muchmoreneedstobedonetounderstandandfullyappreciatethispro- cess. Lessonslearnedfromthiseffortcanbeexpectedtocontinuetopro- videinsightsintoother,relatedfields. Ofthemanycontributorstoour understandingoftheprocessofimplantation,nonehavehadalargerim- pactthanourcolleague,AllenEnders. Dr. Endershasplayedaparamount roleindevelopingthebasicunderstandingofthecellbiologicalprocesses vii VIII Preface underlyingimplantationandplacentationinmanyspecies,includinghu- mans. Hecontinuestocontributeandguidethoughtintheseareas. The participantsofthissymposiumrecognizedDr. Enders'impressivecontribu- tionsbyholdingthiseventinhishonor. DANIELD. CARSON * Contents Preface vii Contributors xiii PartI. Development and Future ofHuman In Vitro Fertilization and Embryo Implantation I. ImplantationintheHumanasViewedbyCanonLaw, CivilLaw,andNaturalReason 3 HOWARDW. JONES, JR. , RICHARDA. MCCORMICK, AND SUSAN L. CROCKIN 2. TheImpactofMaternalAgeandOvarianAge onImplantationEfficiency...12 STEVEN SPANDORFER AND ZEV ROSENWAKS Part II. CellularAspects ofImplantation 3. VascularInvasionDuringImplantationandPlacentation 23 ALLEN C. ENDERS AND THOMASN. BLANKENSHIP 4. OxygenRegulatesHumanCytotrophoblastProliferation, Differentiation,andInvasion:Implicationsfor EndovascularInvasioninNormalPregnancy andPreeclampsia 39 OLGA GENBACEV,YAN ZHOU, MICHAEL T. McMASTER, JOHNW. LUDLOW, CAROLINEH. DAMSKY, AND SUSAN1. FISHER 5. Embryo-MaternalInteractionsafterDiapause inaMarsupial 54 MARILYNB. RENFREE AND GEOFFREY SHAW IX x Contents 6. CellularInteractionsandtheCysteineProteinases intheProcessofMouseImplantation 67 BRUCE BABIARZ, SUZANNE AFONSO, ANDLINDA ROMAGNANO Part III. HormonalRegulation 7. NovelSteroid-RegulatedMarkersofImplantation 83 INDRANIC. BAGCHI 8. MolecularSignalinginImplantation 92 SANJOYK. DAS, BIBHASHC. PARIA, AND SUDHANSU K. DEY 9. IdentificationofProgesterone-RegulatedGenes intheUterus 107 CINDEER. FUNK, BERTW. O'MALLEY, AND FRANCESCO1. DEMAYO PartIV. MolecularMarkersofReceptivity 10. MucinsProvideaBarriertoEmbryoImplantation 123 MARYM. DESOUZA, GULNARA. SURVEYOR, XINHUI ZHOU, JoANNE JULIAN, ANDDANIELD. CARSON II. PotentialInvolvementofTrophinin,Bystin, andTastininEmbryoImplantation 132 MICHIKON. FUKUDA, DAITA NADANO,NAO SUZUKJ, AND JUN NAKAYAMA 12. OsteopontininHumanEndometrium: ARoleinEndometrialReceptivityand EmbryoImplantation? 141 CHRISTOS COUTIFARJS,AKINYINKA OMIGBODUN, PIOTR ZIOLKIEWICZ, AND JOHN HOYER PartV. TrophoblastFactors 13. TheRabbitasaModelforImplantation: InVivoandInVitroStudies 151 LORENH. HOFFMAN,D. RACHEL BREINAN, AND GARETHL. BLAEUER 14. RegulationofTrophoblastEndocrineFunction: ThePlacentaDoesItsOwnThingTranscriptionally...161 JEROMEF. STRAUSSIII ANDLEE-CHUANKAo Contents XI 15. TranscriptionFactorsRegulatingtheDifferentiation oftheTrophoblastCellLineage 167 IANC. SCOTTANDJAMESC.

This book provides surgeons and gastroenterologists with state-of-the-art techniques in terms of advanced colonoscopy. Chapters introduce methods of removing polyps that were not previously amenable to colonoscopic snare polypectomy. Advanced techniques such as closure of perforations and intestinal stenting are extensively covered. The text maintains a strong emphasis on surgical/endoscopic technique. Extensive discussion on equipment and skill acquisition is also covered. As many readers will never have seen these complex procedures before, extensive photographs and video clips are provided. The authors provide tips, tricks, and pitfalls that will help the reader incorporate these new techniques into their practice. Advanced Colonoscopy: Polypectomy and Beyond will be of great value to any surgeon or gastroenterologist currently performing colonoscopy and interested in advanced techniques.

The increasing prevalence of morbid obesity has led the World Health Organization to coin the descriptive term "globesity" to reflect the worldwide nature of the problem. Providing health care to these patients, especially when surgery is required, can be extremely challenging owing to the specific needs in respect of logistics, facilities, and professional expertise. Appropriate care has too often been unachievable and unaffordable outside of established bariatric centers, but such centers themselves usually have insufficient capacity and resources to cope with growing demand. This book aims to provide guidance and helpful tips and tricks on how to deal with obese patients within a general surgery setting. Epidemiology, organizational and logistical aspects, nursing issues, patient assessment, anesthesiology, and surgical practicalities are expertly covered in the opening chapters. Techniques of relevance to the general surgeon are described according to anatomic region, covering the head and neck; cardiothoracic and vascular system; upper and lower GI tract; pancreas, liver and adrenal glands; urinary tract and kidneys; the reproductive system; and the abdominal wall. Results achieved by bariatric surgery worldwide are reviewed, and the book closes with a chapter devoted to plastic and reconstructive surgery. The Globesity Challenge to General Surgery highlights a need for global rethinking on public health as regards resource allocation and patterns and standards of care, improving outcomes through greater affordability.

This authoritative, highly illustrated text and color atlas provides a systematic guide to commonly performed minor surgical and dermatology procedures. Accompanied by video clips, this critical resource on skin and minor surgery is designed for all trainees and practitioners, including experienced surgeons, dermatologists, family doctors, nurses, and the supporting healthcare team. Divided into four main color-coded sections, the book covers essential background information including postoperative management and aftercare, the key knowledge required for diagnosis and management, and the skills necessary to perform procedures step by step. Comprehensive coverage-Learn to perform a whole range of procedures from small skin surgical procedures to vasectomy Step-by-step techniques-See how to perform each technique with numerous color illustrations, animations and video clips Practical advice, boxes, tables, warnings, and indications of difficulty level-Achieve success and avoid common pitfalls Authoritative yet contemporary-Gain wisdom from this long-established, trusted book brought completely up to date by today's practitioners

This is a user-friendly reference on all aspects of office-based anorectal surgery for general surgeons and surgeons in training. Well-illustrated, this practical manual shows step-by-step procedures for commonly performed anorectal procedures. The book includes ancillary considerations of ambulatory surgery with timely chapters on set-up of the facility, anesthetic considerations, selection of patients, pre-op and post-op management, nursing aspects, and coding and billing.

Thanks to the advent of leading-edge technologies, there is a new cross-sectional field of surgery: robotic surgery. Due to the rapid development of robotic surgery systems such as da Vinci, there is a great need to refresh one's knowledge every day. This book covers all surgical areas: urological surgery, digestive surgery, and cardiac surgery in addition to mitral valvular disease. It also summarizes the most current topics in robotic surgery addressed by well-known experts from around the world. These specialists' expertise provides useful insights into modern educational techniques for the latest trends in surgery-knowledge that will be valuable to students, residents, and experts who are eager to learn more about advanced medical care including da Vinci as a cross- cutting surgical device, even if it lies outside their specialty field.

Fundamentals of Surgical Simulation explains in detail, from a behavioural science/human factors perspective, why modern image guided medicine such as surgery, interventional cardiology and interventional radiology are difficult to learn and practice. Medicine is currently at a tipping point in terms of how physicians in procedural based medicine are trained. Fundamentals of Surgical Simulation helps drive this change and is a valuable resource for medical trainers and trainees alike. For trainers, this book gives explicit theoretical and applied information on how this new training paradigm works thus allowing them to tailor the application of simulation training to their program, no matter where in the world they work. For the trainee, it allows them to see and understand the rules of this new training paradigm thus allowing them to optimize their approach to training and reaching proficiency in as efficient a manner as possible. For the simulation researcher, engineer and medical profession Fundamentals of Surgical Simulation poses some difficult questions that require urgent unambiguous and agreed answers.

A symptom-based version of the critically-acclaimed Norton/Surgery: Basic Science and Clinical Evidence, Learning Surgery provides a ready reference to those in third and fourth year residencies. Essential algorithms and case presentations meet with clerkship learning objectives as outlined by the Association of Surgical Education in their ASE Manual. Two sections include Introduction to Clinical Surgery in the Surgical Clerkship Setting and Management of Surgical Diseases During the Clerkship. Chapters include: Stroke, Hypertension, Abdominal Masses, Head Injuries, and Burns. Written by leading clinicians and educators, both surgery residents and medical students will find LEARNING SURGERY indispensible in their rotations and clerkships. Surgeons who train residents will also find the text a valuable ajunct to their teaching.

"Surgical Guide to Circumcision" is a compendium of the who, what, where, why, and most importantly, the how of circumcision. Given that one third of the world s males have undergone this most ancient of surgical procedures, a contemporary resource on the subject is in order.

Most circumcisions are elective with no acute medical necessity; that is, most are done for cultural reasons. Thus, in addition to being a standard surgical guide for those who perform circumcision, this book is an anthology of circumcision, from its prehistoric roots to its present day admixture of religion, culture, and medicine.

"Surgical Guide to Circumcision" is a fully illustrated, step-by-step guide to the most common techniques of circumcision and addresses aspects such as informed consent, religious and cultural sensitivities, pre-exam, post-care, pain control, and prevention and management of potential complications.

Written by experts in the field, "Surgical Guide to Circumcision" will appeal to family physicians, pediatricians, obstetricians, midwives, nurses, urologist, and anyone with a general interest in circumcision. "

The Fruits of Reinvention Surgery related to the human head, its compartment and contents has been reinvented over the past 40 years. A number of instruments, most notably the sophisticated medical imaging device and the operating microscope, have principally fueled this evolution. Along the way, endoscopy and sophisticated navigation capabilities have added to the realization of a unique comprehension of normal and abnormal microanatomy permitting corridors and manipu- tions that allow novel strategies for surgery in these highly vital functional areas. Cappabianca, Califano and Iaconetta have created a detailed and fully modern review of methods and strategies related to complex surgery and therapies associated with this robust reinvention. Technical innovations abound! Distinguished practitioners of these unique developments in the history of surgical - terprise present these amazing technical exercises. The catalog of these approaches, inst- mentation, techniques, strategies and manipulations is inspiring and stands as a testimony to the remarkable progress that we have witnessed in recent decades. The presentation in truly "modern" and represents in many aspects pinnacles of operative achievement. We must ask ourselves, what will be next? Los Angeles, November 2009 Michael L.J. Apuzzo, M.D., Ph.D (hon) Preface We belong to a lucky and happy generation, living during a period of many dramatic, if not revolutionary, technical and technological innovations, such as the digital era, which have changed and improved our routine surgical practice, together with the quality and quantity of life of our patients.

Ophthalmic Microsurgical Suturing Techniques is a reference text for both the novice and the accomplished ophthalmic surgeon. In 15 richly illustrated chapters this book imparts basic information on tissue tactics and knot tying and demonstrates the applicability of these techniques to various microsurgical situations, in both the anterior and the posterior segment of the eye.

The chapters have a uniform reader-friendly format starting with key points to allow rapid reference to the information included in the chapter. Illustrated with photos and line drawings, each chapter contains sections on: Surgical indications, Instrumentation and equipment, Surgical technique, Complications and future challenges.

Those who will benefit greatly from this excellent book include ophthalmic surgeons with widely varying levels of experience, from the resident to the experienced surgeon."

This text provides an overview of the current status of simulation in various surgical disciplines and explains the science of surgical education.

This book discusses the effects of emerging technologies on surgeons and surgical practice. The book opens with an overview of disruptive technologies, and their economic, scientific, ethical and social implications. Next comes a section describing how the Internet, virtual reality and simulation technology will change training and education. A section on Robotics covers computer-guided surgery, robotics and endoluminal therapies. Innovations in surgical instruments, including MEMS and Nanotechnology are outlined, as well. Next, the book reviews tissue engineering and artificial organs, genetic engineering, stem cells, emerging transplantation technologies and the brain-machine interface. A concluding section discusses ways of adapting to future technologies.

Keyhole surgery has been made possible through the rapid development of various medical technologies, first pioneered in the 1970s. Revolutionary in the way it reduced the risk, surgical complications, healing time and scarring compared to open surgery, keyhole surgery soon became the preferred method throughout many surgical specialities.Here, John Wickham, the 'godfather' of robotic surgery, reflects on a life spent in research, discovery and struggle for innovation in order to make keyhole surgery widespread, accessible and available to patients. An Open and Shut Case tracks the evolution of surgery in the later parts of the 20th century, from initial surgical training in the 1960s to the rapid growth in the field of minimally invasive techniques throughout the 1970s and 80s in many specialities, precursors to the techniques used today. It concludes with a look at the effect of the National Health Service on the practice of medicine and nursing in the UK throughout this time.Perfect for surgeons and those interested in the history of surgery and surgical techniques, it also focusses on lessons learnt, both good and bad, when dealing with the management of public health.

Keyhole surgery has been made possible through the rapid development of various medical technologies, first pioneered in the 1970s. Revolutionary in the way it reduced the risk, surgical complications, healing time and scarring compared to open surgery, keyhole surgery soon became the preferred method throughout many surgical specialities.Here, John Wickham, the 'godfather' of robotic surgery, reflects on a life spent in research, discovery and struggle for innovation in order to make keyhole surgery widespread, accessible and available to patients. An Open and Shut Case tracks the evolution of surgery in the later parts of the 20th century, from initial surgical training in the 1960s to the rapid growth in the field of minimally invasive techniques throughout the 1970s and 80s in many specialities, precursors to the techniques used today. It concludes with a look at the effect of the National Health Service on the practice of medicine and nursing in the UK throughout this time.Perfect for surgeons and those interested in the history of surgery and surgical techniques, it also focusses on lessons learnt, both good and bad, when dealing with the management of public health.

The introduction of a new technology in a consolidated field has the potential to disrupt usual practices and create a fertile ground for errors. An example is robotic surgery that is now used in most surgical specialties, pushed by technology developers and enthusiastic surgeons. To analyze the potential impact of robotic surgery on patient safety, a consortium of major European Universities started the project SAFROS whose findings are summarized and further elaborated in the three parts of this book. Part one describes safety in complex systems such as surgery, how this may disrupt the traditional surgical workflow, how safety can be monitored, and the research questions that must be posed. Part two of the book describes the main findings of this research, by identifying the risks of robotic surgery and by describing where its ancillary technologies may fail. This part addresses features and evaluation of anatomic imaging and modeling, actions in the operating room, robot monitoring and control, operator interface, and surgical training. Part three of the book draws the conclusions and offers suggestions on how to limit the risks of medical errors. One possible approach is to use automation to monitor and execute parts of an intervention, thus suggesting that robotics and artificial intelligence will be major elements of the operating room of the future.

This is the illustrated official field manual used by US Army doctors and soldiers in the field. It offers profession, proven advice on dealing with infections, head injuries, fractures, burns, and more. For active-duty soldiers, first-responders, and anyone who might find themselves in a survival situation, it is a remarkable resource. Military surgeons must assume a leadership role in combat casualty care in circumstances that are far less than ideal. This handbook provides much of the information needed to tackle these issues and features state-of-the-art principles and practices of forward trauma surgery as used by military physicians in far flung locations around the globe. Subjects include: Hemorrhage Control Shock and Resuscitation Vascular Access Anesthesia Face and Neck Injuries Thoracic Injuries Wounds and Injuries of the Spinal Column and Cord Amputations Radiological Injuries Biological Warfare Agents Chemical Injuries And much more! Featuring nearly 200 illustrations demonstrating proper techniques, Emergency War Surgery is the most trusted and up-to-date manual offered by the Department of Defense for military medical personnel in the field.

Treating disease can be considered a combat between curative therapies and pathological afflictions. As such, the action of achieving a cure can be likened to successfully waging war on sickness and bodily disorders. Surgical Philosophy applies the core principles derived from Sun Tzu's timeless book Art of War to combating disease through surgery. Its goal is to offer principles, strategies and leadership guidelines for surgeons at all levels and other healthcare practitioners who carry out interventional procedures for the ultimate aim of defeating illness and enhancing the care of patients. In providing a novel and exciting perspective on this ancient text, the book will also be of interest to students of leadership, Eastern philosophy and Chinese history. The book follows eleven sections of the Art of War. Each section reflects the messages in the Art of War, but with a modern surgical point of view. In the book, the role of the surgeon is equivalent to that of a leader or military commander, and the lessons offered in the Art of War are expanded to identify surgical principles and practice.

A panel of recognized authorities comprehensively review the medical, surgical, and pathophysiologic issues relevant to lung volume reduction surgery for emphysema. Topics range from the open technique and video-assisted thoracoscopic approaches to LVRS, to anesthetic management, to perioperative and nursing care of the patient. The experts also detail the selection of candidates for LVRS, the clinical results and clinical trials in LVRS, and the effects of LVRS on survival rates.

With the introduction of cardiac surgery more than five decades ago and the use of the heart-lung machine for open heart surgical procedures granting the surgeon unlimited time in which to operate inside the heart, a complex task has been given to the Perfusionist. With a pairing of a perfusionist and a surgeon for each chapter, this book is an essential collection of techniques and protocols to aid in decision making in the operating room.

This book provides a concise, state-of-the art review of the surgical treatment of metabolic syndrome and diabetes mellitus. The volume reviews what current practices in surgery and metabolic syndrome and diabetes including the biohormonal effects of the different surgeries. Isolating the effects of the different procedures is critical to the decision tree for type of procedure selected for an individual patient. Specifically for diabetes, this textbook will provide a guide for practitioners to a tailored approach to the treatment. Areas of ongoing research that highlight the minimally invasive approach as well as incorporating what we know of the biochemical results of surgery are presented. Results of established weight loss procedures and ongoing trials are juxtaposed against some of the more novel techniques to ascertain a best practice. Metabolic Surgery and the Surgical Treatment of Diabetes serves as a very useful resource for physicians and researchers dealing with, and interested in, this rising epidemic of metabolic syndrome and diabetes. It provides a concise yet comprehensive summary of the current status of the field that will help guide patient management and stimulate investigative efforts.

1. Clinical cases set out as questions that are mapped directly to the curriculum and following the order of the RCoA curriculum 2. A focus on clinical anaesthesia with common cases, that can be used in the clinical environment either for teaching or as a refresher 3. Short, quick-fire cases that enable learning and retention of information with a summary of key points to remember for each question

The only available resource to provide cutting-edge, in-depth coverage of the links between obesity and anesthesia in surgery, the reader-friendly Handbook of Perioperative Anesthesia: Complications and Challenges of the Obese Patient guides the practicing anesthesiologist through each stage of surgery for the obese patient. This clinically relevant text thoroughly illustrates the unique challenges and complications the anesthesiologist faces when supervising and administering drug delivery during surgery. Practical and hands-on, this source also advises the anesthesiologist on how to avoid potential risks and ensure speedy patient recovery post-operation.

Easily referenced, this handbook clearly addresses treatment and management of the obese patient in the three chronological stages of surgery:

• Preoperative - includes information on systemic patient evaluation and surgery preparation, emphasizing related areas of concern in the obese patient (cardiac, pulmonary, endocrine, and others) to help the anesthesiologist foresee how a patient will fare during surgery
• Intraoperative - provides a thorough discussion of the latest in procedural technique, drug and fluid administration, patient monitoring, and airway management
• Postoperative - steps the anesthesiologist can take following surgery to optimize patient results

In addition, this handbook explores special situations that anesthesiologists may encounter during surgery, including the needs of pregnant and pediatric patients, as well as patients with needs outside of the hospital setting.