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Purpose: The surgical resident experience with trauma has changed. Many residents are exposed to predominantly nonoperative patient care experiences while on trauma rotations. Data from a large multicenter study were analyzed to estimate surgical resident exposure to trauma laparotomy, diagnostic peritoneal lavage (DPL), and focused abdominal sonography for trauma (U/S). Methods: Centers completed a self-report questionnaire on their institutional demographics, admissions, and procedure for a 2-year period (1998-1999). Results: A total of 82 trauma centers that provide resident teaching were included. The included centers represent over 247,000 trauma admissions. The majority of trauma centers (65.9%) had > 80% blunt injury. Although all centers performed laparotomies, other results were more variable. For U/S, 24.2% performed none at all and 47.0% performed fewer than two U/S examinations per month. For DPLs, 3.8% performed none and 66.7% performed fewer than two per month. Assuming 1 night of 4 on call, the average surgical resident training at a trauma center performing > 80% blunt trauma has the potential to participate in only 15 trauma laparotomies, 6 diagnostic peritoneal lavages, and 45 ultrasound examinations per year. In addition, the resident will care for an average of 500 blunt trauma patients before performing a splenectomy or liver repair. Conclusion: Surgical resident experience on most trauma services is heavily weighted to nonoperative management, with a relatively low number of procedures, little experience with DPL, and highly variable experience with ultrasound. These data have serious implications for resident training and recruitment into the specialty.

The University of Mississippi Medical Center (UMMC) has become a center for ECMO (Extracorporeal Membrane Oxygenation), providing this service to patients requiring this life-saving modality. UMMC is the only ECMO center in the state. Prior to the cases presented, ECMO use at UMMC has been limited to neonates and the pediatric patient population as well as by the cardiothoracic service for patients with cardiac failure or inability to wean from bypass. The use of ECMO for non-cardiac support in the adult population has been limited in the past, but recent reports in the literature and experience elsewhere has proven the viability of the technology. This is a retrospective report of the first three adult non-cardiac cases employing ECMO for ARDS (Adult Respiratory Distress Syndrome) in Mississippi. We achieved 100% survival in a disease process which reportedly carries a mortality ranging from 20-50%. A brief review of ECMO and its use in this population is also presented.

Injury to the retrohepatic vena cava and hepatic veins carries with it a very high mortality rate. This type of injury is fraught with difficulty because of poor exposure and uncontrolled bleeding. Various techniques for the management of these injuries have been reported. We describe the use of profound hypothermic circulatory arrest to facilitate repair of penetrating injury to the retrohepatic vena cava and hepatic veins.

In a 66-month period 950 major abdominal operations were performed for known or suspected gynecologic malignancy. Thirtyfive patients (3.6%), of whom 29 had proven gynecologic malignancy, underwent cholecystectomy for cholelithiasis known from prior evaluation or found incidentally during abdominal exploration. All cholecystectomies were performed through the original incision with no direct operative morbidity or mortality. Cholecystectomy accompanying gynecologic cancer surgery appears to be well tolerated if performed expeditiously, and avoids the potential of postoperative cholecystitis in this select group of patients.