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Objective To compare the cost effectiveness of percutaneous transluminal coronary artery stenting with minimally invasive internal thoracic artery bypass for isolated lesions of the left anterior descending artery. Design Cost effectiveness analysis. Data sources Embase, Medline, Cochrane, Google Scholar, and Health Technology Assessment databases (1966-2005), and reference sources for utility values and economical variables. Methods Decision analytical modelling and Markov simulation were used to model medium and long term costs, quality of life, and cost effectiveness after either intervention using data from referenced sources. Probabilistic sensitivity and alternative analyses were used to investigate the effect of uncertainty about the value of model variables and model structure. Results Stenting was the dominant strategy in the first two years, being both more effective and less costly than bypass surgery. In the third year bypass surgery still remained more expensive but became marginally more effective. As the incremental cost effectiveness was £1108130. 40 (¿1682146. 00; $2179194) per quality adjusted life year (QALY), the additional effectiveness could not be said to justify the additional cost at this stage. By five years, however, the incremental cost effectiveness ratio of £28 042. 95 per QALY began to compare favourably with other interventions. At 10 years the additional effectiveness of 0. 132 QALYs (range-0. 166 to 0. 430) probably justified the additional cost of £829. 02 (range £205. 56 to £1452. 48), with an incremental cost effectiveness of £6274. 02 per QALY. Sensitivity and alternative analysis showed the results were sensitive to the time horizon and stent type. Conclusions Minimally invasive left internal thoracic artery bypass may be a more cost effective medium and long term alternative to percutaneous transluminal coronary artery stenting. [ABSTRACT FROM AUTHOR]

Objective To compare outcomes between minimally invasive left internal thoracic artery bypass and percutaneous coronary artery stenting as primary interventions for isolated lesions of the left anterior descending artery. Design Meta-analysis of randomised and non-randomised comparative peer reviewed publications. Data sources Embase, Medline, Cochrane, Google Scholar, and Health Technology Assessment databases (1966-2005). Review methods Studies comparing the two procedures as the primary intervention for isolated left anterior descending artery stenosis were identified and the following extracted: study design, population characteristics, severity of coronary artery disease, cardiovascular risk factors, and outcomes of interest. Results 12 studies (1952 patients) reporting results from eight groups were included: one was a retrospective design, one prospective non-randomised, and six prospective randomised. Meta-analysis of randomised trials showed a higher rate of recurrence of angina (odds ratio 2. 62, 95% confidence interval 1. 32 to 5. 21), incidence of major adverse coronary and cerebral events (2. 86,1. 62 to 5. 08), and need for repeat revascularisation (4. 63, 2. 52 to 8. 51) with percutaneous stenting. No significant difference was found in myocardial infarction, stroke, or mortality at maximum follow-up between interventions. Conclusions Minimally invasive left internal thoracic artery bypass for isolated lesions of the left anterior descending artery resulted in fewer complications in the mid-term compared with percutaneous transluminal coronary artery stenting. [ABSTRACT FROM AUTHOR]

Presents the results of an assessment of technical skills in surgery made during training. Methodology; Current methods of assessment in surgery and their limitations; Objective methods of assessing technical skills; Discussion; Conclusion that considerable progress has been made in the past decade in the objective assessment of technical skills, but that there are still some issues that need to be addressed.

Presents an overview of advances in minimal access surgery, concentrating on procedures that have become established in everyday surgical practice. Development of minimally invasive surgery which was facilitated by miniature video cameras with good image reproduction; Methods; Topic of laparoscopy; Minimally invasive abdominal surgery; Sentinal lymph node biopsy; Robotics in surgery.

Features the development of digital cameras that could be used in medicine. Immediate production of digital images; Taking of routine clinical photographs; Picture archiving and communication system; Integration with management systems.

Focuses on medical sciences in Great Britain. Pressures in teaching laparoscopic surgery; Vascular surgery in smokers; Immunodeficiency in the absence of HIV.

The article presents a letter to the editor in response to the article "Risk in primary care of colorectal cancer from new onset rectal bleeding: 10 year prospective study," by Du Toit et al.

Comments on the evolving professional roles of surgeons. Impact of a shortage of physicians on the changing roles of surgeons; Potential benefits and disadvantages of training medical personnel to complete surgery-related procedures; Discussion of the importance of expertise in clinical medicine; View that clinicians in specialized training programs must be trained and monitored to ensure quality of care.

Editorial. Assesses the operative performance and skills of surgeons. Factors that influence surgical outcome; Objective criteria for judging good surgical techniques; Measurement of surgical precision.

This article presents a letter to the editor in response to the article "Anatomy teaching in United Kingdom is in crisis, new report says," by R. Dobson, published in the January 6, 2007 issue.

A letter to the editor is presented in response to the article "Diagnostic accuracy of magnetic resonance imaging in predicting surgical resection margin status: prospective observational study," by the MERCURY Study Group in the September 30, 2006 issue.

Discusses the ethical and scientific issues involved with surgical technology and the use of placebo controlled trials in surgery. Study about sham operations by Moseley et al; Responsibilities of the researcher to act in the subject's best interest; Assessment of the placebo in non-life threatening conditions; Recommendations.